💡By joining this session, you will be able to:

• Understand how proactive frailty screening and management can strengthen care for older adults and support upstream Alternate Level of Care (ALC) avoidance strategies.

• Explore the key components of the Seniors Care Network Frailty Pathways and identify concrete opportunities to weave them into your existing practices.

• Walk away with valuable, real-world lessons and promising practices shared by early adopters who are already seeing success.

Community paramedics are uniquely positioned to support coordinated care through early frailty identification, risk stratification, targeted interventions, and proactive service connections. The decision-tree outlines an innovative Community Paramedicine Frailty Pathway that uses a standardized, stepwise approach to integrate frailty into chronic disease management and ongoing patient monitoring. By facilitating timely referrals to Specialized Geriatric Services, rehabilitation programs, community supports, and other healthcare resources, the pathway promotes proactive frailty management. This approach can improve patient outcomes, reduce avoidable emergency department utilization, and help delay or prevent permanent institutionalization, supporting older adults to remain safely and independently in their communities for longer.

The Central East Cognition Referral Pathway Guidance Document is an evidence-informed resource designed to support the early identification of cognitive concerns and timely access to appropriate services for older adults. Intended for primary care providers and Specialized Geriatric Services (SGS), it provides a structured approach to screening and referral decision-making by incorporating both cognitive and frailty considerations.

The focus of the Pathway is not on directing clinical management. Rather, it supports consistent referral practices, service navigation, and transitions across the continuum. Tested through a regional pilot evaluation, the approach demonstrated potential for alignment between patient needs and SGS connections. Thereby, helping to promote more person-centred care for older adults and their care partners.