Bracknell Forest JSNA Joint Strategic Needs Assessment

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Frailty

A JSNA deep dive for Bracknell Forest

Who is living with frailty in Bracknell Forest, what drives it, and where earlier identification and support would change the trajectory.

At a glance

21,000 adults in Bracknell Forest have at least mild frailty — around 18% Connected Care

12–22% range in frailty prevalence across the borough's wards Connected Care

16% of the Bracknell Forest population is aged 65 and over Office for National Statistics

£2bn estimated annual national NHS cost of hip fracture treatment and associated care Royal College of Physicians

Overview and analysis

What is Frailty and why is it important?

Frailty is a clinical condition linked to the decline of physical and psychological reserves often associated with the ageing process.¹ It is a health state linked to losses in physical, cognitive and social functioning² and increases an individual’s vulnerability to everyday or acute stressors such as infections, falls or change in environments. For people living with frailty, these minor events can trigger health changes which the patient may struggle to recover from. It is associated with increased risks of loss of independence, falls, disability, extended hospital stays and mortality. Frailty is also associated with an increased risk of dementia, particularly if it co-occurs with depression.³, ⁴

While frailty is most commonly associated with older age, emerging evidence suggest frailty presentations are being seen in young cohorts with long-term conditions and health inclusion groups (e.g. people experiencing homelessness and co-occurring needs).

It is important to note however that frailty is not the same as ageing, multi-morbidity or cognitive decline and that many older people remain in good health. Evidence suggests a bidirectional association between multimorbidity and frailty. An estimated 70% of older adults with frailty have multimorbidity but only 16% of older people with multimorbidity are also living with frailty. Frailty can also occur in younger adults particularly those who are vulnerable or have long-term conditions.

Below are the five frailty syndromes that people commonly present with:

• Falls (e.g. collapse, legs gave way)
• Immobility (e.g. sudden change in mobility)
• Delirium (e.g. acute confusion, sudden worsening of confusion in someone with previous dementia or known memory loss)
• Incontinence
• Susceptibility to side effects of medication (e.g. confusion with codeine, hypotension with antidepressants)

The British Geriatrics Society emphasises the importance of identifying frailty to improve outcomes and reduce unnecessary harms. Frailty is a spectrum condition that can be assessed in primary and community care settings using a range of tools. At a population level, the Electronic Frailty Index (eFI) uses routinely collected data in primary care to identify and stratify mild, moderate and severe frailty.⁵ Identification enables care providers to address factors contributing to frailty or take proactive approaches to manage risks by having a shared care plan in place.

Research also shows that frailty can be reversed following effective management of contributory factors such as polypharmacy, hospitalisation, and falls.⁶ This highlights the importance of early identification of frailty, assessment and management of risks or conditions that contribute to worsening of frailty.

This JSNA profile provides an overview of the national and local policy context, a detailed epidemiological analysis, a high-level description of pathways and local services, and a summary of insights from stakeholders including people with lived experience.

National and local policy context

The Chief Medical Officer’s (CMO) 2023 Report on Health in an Ageing Society identifies maximising independence and improving the quality of life for older people as a policy priority for England.⁷

The NHS long term plan⁸ focused on a proactive approach of assessing risks, identification and making support available. This was followed by the FRAIL strategy⁹ to support the delivery of acute frailty services.

The past few years have seen a significant shift in national policy towards supporting people with frailty to live well at or closer to their home through community-led initiatives. In December 2023 NHS England published the proactive care framework¹⁰, which supports a more ‘consistent approach to proactive care across the country for people living at home with moderate or severe frailty’. The guidance provides some examples of best practice as well as five core components of the proactive care approach including case identification, holistic assessment, personalised care and support planning, coordinated and multi-disciplinary working, and continuity of care.

The 10 Year Health Plan emphasised shifting care from hospitals and community with a focus on better identification, care pathways and management of frailty through neighbourhood health teams. The Thames Valley Commissioning Intentions 2026 to 2030¹¹ includes commitment to the following strategic objectives to guide their commissioning:

• Maximising value
• Integrated and proactive neighbourhood health
• Prioritising prevention

This builds on the development and delivery of proactive care in the community which is a key priority in the Bracknell Forest health and care plan 2025-26.¹²

Epidemiology analysis and inequalities

Using national survey data, it has been estimated that around 8.1% of people aged >50 years in England are affected by frailty, with prevalence increasing to around 50% in people aged >90 years.¹³ This study also found Bracknell Forest to be a local authority with one of the lowest estimated prevalence of frailty.

However, a comparison between estimated frailty prevalence¹⁴ and local eFI data obtained from Connected Care points to some differences in the estimates.

Figure 1 Comparison of current estimated frailty prevalence based on Connected Care data and estimated frailty prevalence applied to Bracknell Forest (BF) population

level	Connected Care	Estimated Frailty Prevalence applied to BF population13
Mild	14,758	8,807
Moderate	4,016	2,162
Severe	1,873	446

Source: Connected Care; estimated prevalence applied to the Bracknell Forest population

This suggests that around 21,000 (18%) of the adult population of Bracknell Forest have at least mild frailty, less than 10% (around 1,800 people) of them are classified with severe frailty. Further analysis of the Connected Care data shows the range by Ward is from around 12% to 22%.

Figure 2 Current estimated frailty prevalence based on Connected Care data by Ward within the Borough

Source: Connected Care

View the data as a table

ward	frail	total_population	percent_frail
Hanworth	1,751	7,877	22.2
Whitegrove	1,330	6,087	21.8
Great Hollands	2,088	10,021	20.8
Crowthorne	1,032	5,055	20.4
Sandhurst	1,657	8,336	19.9
Harmans Water & Crown Wood	1,972	10,026	19.7
Priestwood & Garth	1,755	8,976	19.6
Bullbrook	1,412	7,252	19.5
Easthampstead & Wildridings	1,861	9,581	19.4
Winkfield & Warfield East	315	1,676	18.8
Swinley Forest	806	4,467	18.0
Owlsmoor & College Town	1,399	8,015	17.5
Binfield North & Warfield West	1,094	7,481	14.6
Town Centre & The Parks	737	5,826	12.7
Binfield South & Jennett's Park	1,438	11,450	12.6

Emergency hospital admissions due to falls and hip fractures are key indicators of the burden of frailty in a local population and are among the most widely used metrics for benchmarking frailty-related harm across local authority areas. Falls are the leading cause of injury-related mortality in people aged 65 and over in England, and hip fracture in particular carries significant consequences. The financial cost is also substantial with hip fracture treatment and associated care costing the NHS an estimated £2 billion per year nationally.¹⁵

Figure 3 Emergency hospital admissions due to falls in people aged 65 and over in Bracknell Forest, South-East and England (per 100,000)

Source: OHID Public Health Profiles, Hospital Episode Statistics. Hospital Episode Statistics missing for 2022/23.

View the data as a table

period	Bracknell Forest	South East	England
2010/11	1,735	2,093	2,126
2011/12	2,374	2,079	2,128
2012/13	2,150	2,048	2,100
2013/14	1,974	2,139	2,160
2014/15	2,179	2,164	2,209
2015/16	2,508	2,150	2,184
2016/17	2,521	2,153	2,133
2017/18	2,553	2,212	2,194
2018/19	2,805	2,181	2,228
2019/20	2,422	2,363	2,256
2020/21	2,109	2,176	2,062
2021/22	1,994	2,192	2,100
2022/23	NA	1,839	1,933
2023/24	2,010	2,027	1,983
2024/25	1,799	2,018	1,958

Figure 4 Hip fractures in people aged 65 and over in Bracknell Forest, South-East and England (per 100,000)

Source: OHID Public Health Profiles, Hospital Episode Statistics. Hospital Episode Statistics missing for 2022/23.

View the data as a table

period	Bracknell Forest	South East	England
2010/11	568	618	615
2011/12	666	608	612
2012/13	595	584	600
2013/14	499	617	616
2014/15	577	585	601
2015/16	641	566	593
2016/17	544	565	580
2017/18	471	564	584
2018/19	598	524	566
2019/20	489	560	581
2020/21	589	518	539
2021/22	482	536	551
2022/23	NA	508	558
2023/24	559	535	547
2024/25	460	518	536

Data quality Data quality issues, particularly relating to non-submission and missing diagnosis codes, are identified in both indicators for the South-East region and Bracknell Forest. For more information, visit the respective Fingertips Public Health profile.

Dashboard — link to come A Power BI dashboard covering frailty will be published alongside this chapter. The link will be added here once it is live.

Who has an increased risk of living with frailty?

Older age groups

• The decline in physiological systems associated with ageing increases older people’s vulnerability to frailty¹⁶
• Older people aged 65 and above makes up around 16% of the total population in Bracknell Forest

Deprivation

• Living in areas of greater deprivation in mid to late adulthood increases the risk of frailty incidence¹⁷,¹⁸ Aside from association of less healthy lifestyle and higher mortality risk in areas of deprivation, other possible causes highlighted include both the physical environment (e.g. environmental degradation and proximity to major roads) and the characteristics of the neighbourhood (e.g. perceived safety).¹⁹
• There are no Lower-layer Super Output Areas (LSOAs) in Bracknell Forest in the 20% most deprived nationally however a number of neighbourhoods fall below the national median, indicating pockets of relative deprivation within the borough.

Female sex

• Females are considered both less frail as they tend to live longer than males but also frailer as they tend to experience greater levels of co-morbidity.²⁰
• Around 54% of older people aged 65 and above are female

Asian ethnicity

• Findings from a longitudinal study of primary care data show²¹ highest frailty incidence in Asian ethnic groups with incidence rates of 57.3 per 1,000 compared to 42.8 per 1,000 in Mixed/Other, 49.1 per 1,000 in Black and 50.9 per 1,000 in White ethnic groups
• Based on the Census 2021 data, around 7% of the Bracknell Forest population are from Asian ethnic communities, this reduces with age and for those aged 60 to 74 around 4% and just over 2% of those aged 75 and over are from Asian ethnic communities.

Risk and protective factors

To prevent frailty, dementia and disability in older people, NICE guidelines (NG16)²² recommends developing population-level initiatives to encourage healthy behaviours starting from mid-life. Modifiable risk factors include physical activity, healthy diet, smoking and alcohol consumption.

Physical activity

Higher levels of physical activity is associated with lower risks of frailty and may be effective in preventing the onset of frailty.²³ Evidence also suggests that multi-dimensional physical activity-based interventions (e.g. aerobic, strength, balance) in patients with frailty were associated with improvement in frailty status.^{24 25}

The CMO recommends that adults should do at least 150 minutes of physical activity a week.²⁶ Findings from Active Lives Survey indicate that the proportion of adults that meet this recommendation in Bracknell Forest has remained below the pre-pandemic level (see Figure 5 below). In 2023/24, around 65% of adults are physically active in Bracknell Forest which is lower than the England average. This has increased to 73% in 2024/25.

Figure 5 Time series showing the percentage of physically active adults in Bracknell Forest compared to South-East and England

Source: Sport England Active Lives Survey

View the data as a table

period	Bracknell Forest	England	South East
2015/16	68.1	66.1	68.7
2016/17	72.2	66.0	68.9
2017/18	73.9	66.3	69.8
2018/19	71.8	67.2	70.2
2019/20	71.1	66.4	69.5
2020/21	65.5	65.9	69.2
2021/22	69.6	67.3	70.5
2022/23	68.4	67.1	70.2
2023/24	65.6	67.4	70.5
2024/25	73.1	68.0	70.9

There is also a clear social gradient in that people living in more deprived neighbourhoods (lower deciles) are less physically active than those living in more affluent areas.

Figure 6 Proportion of physically inactive and physically active adults by IMD

Source: Sport England Active Lives Survey

View the data as a table

measure	period	Deciles 4 to 7	Deciles 8 to 10
Physically active	2015/16	62.5	69.8
Physically inactive	2015/16	21.6	16.4
Physically active	2016/17	70.1	67.9
Physically inactive	2016/17	20.5	18.0
Physically active	2017/18	67.8	72.7
Physically inactive	2017/18	21.3	15.5
Physically active	2018/19	56.9	74.6
Physically inactive	2018/19	28.7	11.9
Physically active	2019/20	61.4	73.0
Physically inactive	2019/20	25.3	15.0
Physically active	2020/21	51.5	66.2
Physically inactive	2020/21	36.6	21.2
Physically active	2021/22	62.3	69.5
Physically inactive	2021/22	25.5	17.9
Physically active	2022/23	55.3	66.2
Physically inactive	2022/23	26.7	19.4
Physically active	2023/24	57.1	64.2
Physically inactive	2023/24	32.0	22.0

Frontline professionals and residents highlighted that key barriers include the lack of accessible community transport particularly for older people, as well as limited awareness of physical activity opportunities. Information disseminated digitally may not effectively reach older people who have limited access to digital tools. Similarly, professionals who work with older people may not always have up to date information about local groups and opportunities to engage in physical activity.

Healthy diet

There is some evidence that points to nutrition as a potential modifiable risk factor for frailty. In the English Longitudinal Study of Ageing (ELSA), older adults who had a daily consumption of 5–10 portions of fruit and vegetables, had a lower risk of pre-frailty or frailty when followed-up over four years.²⁷ However, there is limited evidence to inform the design of dietary interventions to prevent and/or delay the onset of frailty.²⁸

The proportion of adults meeting the ‘5-a-day’ fruit and vegetable consumption recommendations was historically low in Bracknell Forest compared to the national average, but this has recently increased. In 2024/25, 34.4% of adults in Bracknell Forest are meeting the ‘5-a-day’ recommendations compared to 35% in the South-East region or 31.4% nationally.

Figure 7 Proportion of adults meeting the 5-a-day recommended fruit and vegetable consumption

Source: OHID Public Health Profiles

View the data as a table

period	Bracknell Forest	England	South East
2020/21	30.6	34.9	37.7
2021/22	29.4	32.5	35.2
2022/23	29.3	31.0	33.2
2023/24	28.3	31.3	34.6
2024/25	34.4	31.4	35.0

Smoking and alcohol or drug dependency

Studies have shown that smoking is associated with increased likelihood of developing and worsening frailty.²⁹,³⁰,³¹ Although there is limited evidence regarding the relationship between alcohol consumption and risk of frailty, it is associated with increased risk of falls in older people.³²

Smoking rates among routine and manual workers and adults with long-term mental health conditions remain high at 27.3% and 14.3% respectively in 2022-24.³³

Emerging evidence also suggests an intersection between frailty, mental health and substance use. Professionals described a cohort of individuals with multiple disadvantage, presenting with physical and mental health needs, alcohol or drug dependency, whose complexity does not fit clearly within a single service pathway. The risk of frailty in this cohort is a consequence of cumulative disadvantage and its management requires integrated working across relevant services.

Other risk factors and factors affecting outcome of people living with frailty

Older people living with multiple chronic conditions are also at higher risk of frailty.³⁴ In particular, evidence suggests long-term conditions including diabetes, cognitive impairment and polypharmacy contribute to the development and worsening of frailty.³⁵ Prevention of poor health and long-term conditions during mid-life should be a key element of promoting healthy ageing.³⁶

Social isolation and loneliness increase the risk of development of frailty³⁷. Co-occurrence of frailty with social isolation or loneliness is common in areas of higher deprivation and is found to increase the risk of hospitalisation and mortality.³⁸

Early identification, assessment and provision of appropriate advice and interventions could reduce the risk of frailty worsening and prevent the need for long-term care.³⁹ Interventions could include increasing moderate physical activity, balance and muscle strength improvement, risk factor assessment, nutrition, appropriate polypharmacy and signposting and health promotion in nursing care services and care co-ordination.

System challenges

Discharge and step-down pathway

Professionals highlighted a potential gap particularly in relation to inpatient care rehabilitation capacity and supported community options for people who are not ready to return home independently.

A particular issue highlighted was in relation to rising homelessness in the older population aged 60 to 75 leading to prolonged hospital stays or placements leaving them at higher risk of deconditioning and frailty.

Local services and assets

Local authority

• NHS health checks are commissioned for 40-70 year olds to help prevent heart disease, stroke, diabetes and kidney disease
• NHS diabetes prevention programme as opportunities to encourage people to improve health behaviour and reduce risks
• Making Every Contact Count (MECC)⁴⁰ approach to improve workforce capabilities and supporting behaviour change
• Intermediate support care at home including reablement and adaptations
• All Age Integrated Carers strategy 2024 to 2029 identifies working collaboratively with partners to improve access to support and services to meet carers’ health needs
• Adult Social Care Hub serves as the front door for adult social care in Bracknell Forest, providing triage, safeguarding functions, and onward referral to relevant teams including the Early Intervention and Prevention Team (EIP), Adult Community Team (long-term assessment and care act work), the Community Mental Health Team, and specialist services for people with learning disabilities.
• The Early Intervention and Prevention (EIP) team is an integrated team, with Berkshire Health Care Foundation Trust. The team works with local Primary Care Networks (PCNs), including social prescribing teams as well as the voluntary and community sector and provides a suite of wellbeing services for people who do not meet the threshold for long-term social care but whose needs, if unmet, risk deteriorating. The EIP offer includes a six-week reablement programme delivered by social workers, occupational therapists, nurses, and coordinators; Intermediate Care Service (community-based support); falls clinic; Sensory Needs Service; tech-enabled care and connections to health partners. The team also includes falls prevention work and community therapy input, supporting people to maintain function and independence at home.

NHS Primary and Community Care

• Proactive Care aims to identify and provide extra support to people who are at risk of increasing frailty using GP data and through multi-disciplinary working, offering them earlier support and help to stay in the place they call home longer. This is currently only being delivered in The Health Triangle PCN.
• The Locality Access Point (LAP) meets daily which consist of a multi-disciplinary team made up of mental health (older people), community matron, social worker and occupational therapy teams. This is the meeting where proactive cases are presented by Health Triangle (PCN), offering a holistic approach to proactive care planning. Complex individuals, with needs requiring the support of the geriatrician (Comprehensive Geriatric Assessment, or CGA) are discussed at the monthly cluster meeting.
• Urgent community response teams provide face to face urgent care to people in their homes (including care homes) which helps to avoid hospital admissions and enable people to live independently for longer.
• The Frailty Virtual Wards help prevent hospital stays by supporting people in their own home or care home if they suddenly become unwell
• Social prescribing enables people to be referred to activities in the community where available e.g. exercise groups
• Comprehensive Geriatric Assessment (CGA) is used in hospital settings to assess frailty, generate a frailty score and inform the level of social care required
• Assessment and Rehabilitation Centre provided in Bracknell Healthspace

Hospital Care

• Fracture liaison services provided by Royal Berkshire NHS Foundation Trust

Voluntary and Community Sector

• Voluntary and Community Sector (VCS) offer opportunities such as group walks, Revive cafe to combat social isolation, community transport. VCS may be facing challenges relating to sustainability of funding and resources.
• Dementia Advisory Service and a comprehensive Dementia Directory
• Signal4Carers and a wider carers support and information
• Andy’s Man Club, a men’s mental health peer support group, currently supports 60–70 people per week in Bracknell Forest
• Social prescribing links people to a range of community activities and groups, including sports centre-based falls prevention programmes, walking groups, and social activities
• Age Concern provides regular community-based activities and day trips
• Age UK Berkshire offers the ‘home from hospital service’ in Bracknell.

Green spaces

• Bracknell Forest boasts a high level of green space with 39% woodland coverage and over 150 parks

Areas for improvement

• Promote healthy ageing behaviours from mid-life following NICE NG16 evidence base. This should include targeted physical activity promotion for adults aged 40 to 65 with a particular focus on strength, balance and aerobic activities known to reduce frailty risk, nutritional guidance and support, particularly for people with long-term conditions, smoking cessation support and alcohol awareness. Delivery should make use of existing touch points including NHS Health Checks, NHS Diabetes Prevention Programme, and social prescribing and should not rely on digital channels
• Embed frailty awareness and Making Every Contact Count (MECC) across the workforce to improve early identification and intervention
• Strengthen falls prevention as a system-wide priority and particularly targeting population at particularly high risk of falls and deconditioning (e.g. Care home residents)
• Consistent implementation of a proactive care model across Bracknell Forest is a gap in the infrastructure for early frailty identification. The Health and Wellbeing Board (HWB) and PCNs should work collaboratively to understand and address barriers to implementation. Following this, agree a timeline and plan for implementation with particular attention to people who may have limited GP contact (to ensure high diagnosis rates for people with potential mild frailty).
• Improve carer identification and support as part of frailty prevention as carers of people living with frailty are themselves at elevated risk of physical and mental health deterioration, social isolation and frailty (in the longer term). Bracknell Forest Carers Strategy commits to working collaboratively with partners to improve access to support for carers, and this commitment should be operationalised specifically in the context of frailty as well.
• Consider polypharmacy as a modifiable risk factor for frailty and falls
• Develop a local data and outcomes framework for frailty drawing on NHS RightCare Frailty Toolkit and should include, as a minimum: prevalence of mild, moderate, and severe frailty by GP practice and ward; rates of frailty-related emergency admissions and readmissions; uptake of Comprehensive Geriatric Assessment and proactive care planning; carer identification rates; and patient-reported outcomes from reablement and intermediate care.
• Develop an integrated pathway for people living with frailty and co-occurring multiple disadvantage considering the increasing ageing population and anecdotal evidence of rising homelessness in this age group.
• Strengthen the VCS offer and relationships following the recognition of reduced VCS capacity. The Health and Wellbeing Board should prioritise sustainable funding and partnership arrangements with VCS organisations providing falls prevention, social engagement and community transport for older people.
• Address transport as a barrier for access which was identified as a significant and practical barrier to accessing preventive services (e.g. falls prevention, physical activity) and community services for older people
• Information dissemination should not rely solely on digital channels

References

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2. Dlima SD, Hall A, Aminu AQ, Akpan A, Todd C, Vardy ERLC. Frailty: a global health challenge in need of local action. BMJ Global Health. 2024;9:e015173.

3. Petermann-Rocha F, Lyall D, Gray S et al. (2020) Associations between physical frailty and dementia incidence: a prospective study from UK Biobank. The Lancet Healthy Longevity, 2020; 1, e58-e68

4. Ding Y, et al (2025) Associations of physical frailty, depression and their interaction with incident all-cause dementia among older adults: evidence from three prospective cohorts. Gen Psychiatr. 2025 Dec 16;38(6):e102172

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38. Politis, M., Crawford, L., Jani, B.D. et al. (2024) An observational analysis of frailty in combination with loneliness or social isolation and their association with socioeconomic deprivation, hospitalisation and mortality among UK Biobank participants. Sci Rep 14, 7258.

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