Abstract Aim The aim of the study was to reach consensus on modifiable risk factors for a novel system of care to address Manifestations of Frailty in hospitalized older adults. Design Consensus study. Method A modified nominal group technique, incorporating expert group face‐to‐face interaction, review of existing evidence and pre/post‐meeting questionnaire completion was undertaken November 2019–February 2020. Results Seventy‐one risk factors, within seven risk factor domains (pain, medication, fluid and nutrition intake, mobility, elimination, infection, additional patient factors) were considered. It was agreed that 44 risk factors incorporating patient, organizational and environmental risk factors were modifiable and should be included in a novel system of care.