Be Your Best: an innovative, co-designed approach to frailty and care transitions from hospital to home, in people aged 65 years or more.

Frailty is a condition in which the individual is vulnerable and at increased risk of poor health outcomes or death when exposed to a stressor, such as illness or injury. As we age, frailty is common, affecting one in two people aged 65 years or more. Be Your Best is a program that has been co-designed with health consumers, to address frailty in people aged ≥65 years after hospital discharge. This proposal seeks funding to conduct a feasibility and acceptability study of the Be Your Best program. The program involves a needs-based assessment of people aged ≥65 years after hospital discharge to determine which existing community-based interventions would best meet their needs and prevent or overcome frailty. Interventions will include addressing physical mobility and exercise, nutritional support; cognitive stimulation, or social support. Participants will be visited in their homes at 1 week post-hospital discharge to determine their needs, and interventions will be guided by participant choice. Follow-up telephone calls will occur at 1 month, 3 months and 6 months after discharge from hospital. Program sustainability and evaluation will be measured at 12 months, including outcomes related to the family carer as applicable. Participant General Practitioners will be engaged throughout.