Arun lives with mild frailty, diabetes and arthritis. He is 78. His practice nurse has advised him to walk more and improve his diet. He understands the advice, but he is worried about falling. His knees hurt. Since his wife died six months ago he rarely cooks properly for himself. When asked what matters most, he says, “I just want to be able to get to the temple again without feeling like a burden.”
That answer changes the conversation. The goal is no longer simply “increase physical activity” or “improve nutrition”. It becomes a conversation about confidence, grief, pain, transport, social connection, food, faith and independence. A coaching approach helps turn general advice into a personally meaningful first step.
Most people living with frailty have been given advice.
They may have been told to move more, eat better, use their walking aid, take their medication, attend appointments, join a group, drink more fluids, avoid falls, or ask for help sooner. Much of that advice may be clinically appropriate. Some of it may be
essential.
But advice is not the same as change.
This is especially true in frailty. When someone is experiencing reduced strength, low energy, pain, fear of falling, loneliness, low mood, cognitive change, multiple appointments, medication burden or loss of confidence, even a small change can feel enormous. The issue is not usually that people do not care. More often, the issue is that the gap between knowing and doing has become too wide.
This is where coaching has real value.
A coaching approach helps practitioners move from simply giving advice to supporting activation. Activation is about a person’s confidence, knowledge, skills and motivation to manage their health and wellbeing. It is not about blaming people for their situation. It is about recognising that people are more able to act when they feel confident, supported and connected to a goal that matters to them.
The evidence base for patient activation is relevant here. A systematic review and meta-analysis by Anderson and colleagues (2022) found that higher patient activation was associated with reduced risk of hospitalisation and emergency department use among adults with chronic conditions. This does not prove that activation alone prevents crisis, but it does support something many practitioners know from experience: when people feel more able to manage, navigate services and take action, outcomes can improve.
There is also growing evidence for health coaching. A recent UK primary care evaluation of Structured Agenda-free Coaching Conversations, known as StACC, involved people with long-term conditions and multimorbidity. The model used five or six personalised one-to-one coaching sessions, delivered by trained non-clinical coaches. It was strengths-based and focused on ownership, engagement and what mattered to the person rather than simply transferring health-related knowledge. The evaluation found improvements in patient activation and self-management capabilities, with participants describing taking action and gaining more control (Henry et al., 2025).
We need to apply this evidence carefully. The StACC study was not specifically a frailty intervention, and the direct evidence for coaching in frailty is still developing. But the relevance is strong. Many people living with frailty are also living with multimorbidity, complexity, reduced confidence and frequent service contact. The need is rarely for information alone. The need is for conversations that help people make sense of their situation and identify what they can realistically do.
In frailty care, a coaching approach might begin with:
“What would you most like to be able to keep doing?”
“What has become harder recently?”
“What worries you most about your health at the moment?”
“What gives you confidence on a better day?”
“What feels like a realistic first step?”
These questions are practical behaviour change questions. They help identify motivation, barriers, strengths, support and readiness. They also help avoid the trap of assuming that professional priorities and personal priorities are the same.
A practitioner may be focused on falls risk. The person may be focused on getting back to the garden. A clinician may be concerned about nutrition. The person may be embarrassed that they can no longer cook for themselves. A care coordinator may be thinking about a package of support. The person may be worried that accepting help means losing independence. A social prescriber may see isolation. The person may describe grief, shame or fear.
Coaching helps connect these worlds.
It also helps turn broad advice into specific action. “Be more active” becomes “walk to the front gate with your daughter on Tuesday and Friday.” “Eat more protein” becomes “add yoghurt at breakfast three days this week.” “Reconnect socially” becomes “phone the lunch club and ask whether someone could meet you at the door.” “Use your walking aid” becomes “try it indoors first and notice whether it helps you feel steadier.”
These small steps can matter. Frailty is often affected by patterns that accumulate over time: less movement, less strength, less confidence, less connection, less nourishment. Reversing those patterns usually starts with something modest enough to feel possible. Coaching supports this by using goal setting, confidence scaling, action planning and follow-up. It also creates space to revisit plans without shame when life gets in the way.
This is particularly important because frailty often changes how people see themselves. A fall, a diagnosis, a hospital admission or the need for support can threaten someone’s identity. People may resist help because it feels like giving in. They may avoid activity because they are afraid. They may decline social opportunities because they feel embarrassed. A coaching conversation can explore these feelings without judgement.
For example, imagine someone who has stopped going out after a fall. The advice might be: “You need to keep active.” The coaching conversation goes deeper: “What has changed for you since the fall?” “What would you like to feel confident doing again?” “What would make a first step feel safe enough?” The plan might include a physiotherapy referral, a medication review, strength and balance exercises, a supported first walk, or reconnecting with a friend. The difference is that the plan is built with the person, not simply handed to them.
This is central to personalised care in health and social care. It recognises that people are not passive recipients of services. They are people with values, relationships, histories, worries and hopes. Coaching helps practitioners work with that reality.
It is also important for staff. Many practitioners want to support behaviour change but feel under pressure to fix, advise or move quickly to the next task. Coaching gives them a structure for more effective conversations. It does not require every conversation to be long. Even a brief shift in language can make a difference: “What matters most to you?” “How confident do you feel?” “What would help?” “What is the next small step?”
In frailty care, behaviour change is not about persuading people to comply. It is about helping people reconnect with agency. It is about creating the conditions in which people can take supported action.
Advice tells people what might help. Coaching helps them find a way to begin.
References
Anderson, G., Rega, M. L., Casasanta, D., Graffigna, G., Damiani, G., & Barello, S. (2022). The association between patient activation and healthcare resources utilization: A systematic review and meta-analysis. Public Health, 210, 134–141.
Guo, Y., Miao, X., Hu, J., Chen, L., Chen, Y., Zhao, K., Xu, T., Jiang, X., Zhu, H., Xu, X., & Xu, Q. (2024). Summary of best evidence for prevention and management of frailty. Age and Ageing, 53(2), afae011.
Henry, K., El-Osta, A., & Leedham-Green, K. (2025). Health coaching for people with long-term conditions and multimorbidity: A mixed methods prospective service evaluation of Structured Agenda-free Coaching Conversations in UK primary care. BMC Public Health, 25, 2365.
NHS England. (2017). Toolkit for general practice in supporting older people living with frailty. NHS England.
