The Frailty and Elder Care Network (FECN) consists of a multidisciplinary team dedicated to improving the health of older adults in Nova Scotia, with a focus on identifying and managing frailty. The FECN promotes healthcare planning that is evidence-based, older adult-centered, and collaborative, continually improving through evaluation and active engagement with all stakeholders.
Become an older adult-friendly organization
Promote dignity and autonomy in aging by exploring and questioning ageist attitudes and values in current healthcare practices
Focus on a system approach to understanding, assessing and managing frailty
Increase the awareness, identification and management of frailty across care settings and communities
Work towards reducing unintended hospital harm
Integrate focused approaches that enable older adults to maintain their functional independence so they can recover fasted and return home sooner
Identifying, evaluating, and addressing frailty enables healthcare teams across community, primary, and acute care settings to integrate frailty assessments into their care planning. This approach facilitates the development of individualized, goal-directed, and patient-centred care plans tailored to each person’s unique needs. By delivering focused interventions, health teams aim to prevent, delay, or potentially alter the progression of frailty.
The DoR Program aims to shift the attitudes and approaches of direct care staff and essential care partners to enhance how we support older adults living with frailty or dementia. The goal is to better uphold their autonomy and preferences while optimizing health outcomes in both hospital and community settings. We recognize that achieving this requires a cultural shift—one that acknowledges and addresses existing gaps in the care of older adults facing these challenges. To this end, we're committed to working in collaboration with healthcare and community stakeholders to align and unify messaging around the care of older adults.
The DoR Program offers workshops for direct care staff that focus on addressing and reducing ageism, overprotective attitudes, fear of liability, and an excessive emphasis on safety. These sessions help staff build their skills in identifying frailty levels and the associated functional risks in older adults. A key component of the training is the application of an evidence-based risk management approach to care planning, along with coaching essential care partners to strengthen their ability to support those they care for. Staff are also equipped to recognize the importance of involving individuals in decision-making—even when those decisions involve reasonable risks. This approach promotes dignity, well-being, and a higher quality of life for older adults.
The DoR program is also developing an acute-care, on-site “Frailty and Dignity of Risk Informed Care” pilot to further support behaviour change among direct-care staff. This pilot will be evaluated for effectiveness and sustainability.
Promoting mobility is a key component of the overall care pathway. This provincial initiative ensures that older adults living with frailty—who are at highest risk of losing function due to immobility during hospital stays—receive timely, targeted and purposeful mobility interventions.
Seniors' Care Teams (SCTs) are collaborative, interprofessional teams embedded within select regional emergency departments (EDs). These teams are dedicated to enhancing care for older adults and improving overall system efficiency. By integrating SCTs directly into EDs, this initiative aims to reduce preventable hospital admissions and readmissions among seniors.
A proactive approach to care helps improve patient outcomes and quality of life, supporting older adults in remaining at home whenever possible. SCTs are designed to bridge the gap between hospital and community care by supporting older adults and their essential care partners in the ED and providing follow-up in the community to ensure a smooth transition home.
Delirium is often confused with dementia because the symptoms can be similar. Unlike dementia, delirium develops suddenly—over the course of hours or days—and affects a person’s behaviour and thinking. Delirium can indicate a change in a person’s health. It is considered a medical emergency.
