The percentage of citizens aged over 65 years is predicted to rise from 18% to 28% by 2060; the percentage of over-80s will increase from 5% to 12% during the same time period, becoming as numerous as young people are now in 2016 (European Commission, 2015). These demographic trends suggest that there will be an increase in age-related disability and functional dependence, which will ultimately impact not only the wellbeing of the individuals affected (disability being a major factor determining quality of life), but also the sustainability of healthcare systems (Murray & Lopez, 2013).
This implies that there is a need to re-shape healthcare systems in order to better address emerging public health challenges, particularly the needs of older people, independent of socioeconomic background. Consequently, the models of care should take into account the need to approach older people not just in terms of curing diseases, but also in terms of care and support to prevent functional decline, frailty and disability.
There are several definitions of frailty and the JA JAHEE recognised the definition of the World Health Organisation (WHO, 2015) as being most representative.
“Frailty is a progressive age-related decline in physiological systems that results in decreased reserves of intrinsic capacity, which confers extreme vulnerability to stressors and increases the risk of a range of adverse health outcomes” (WHO, 2015).
The prevalence of frailty reported in multiple studies on community cohort samples globally ranges from 2% to 60%, contingent on factors such as the age of the population studied and the frailty assessment instrument or classification used. Nine out of every ten studies reviewed, reported prevalence rates below 30% and half reported rates above 11%. This is consistent with the global weighted prevalence of 11% reported in a recent systematic review of community-dwellers over 65 years old (Collard et al., 2012).
There are far fewer studies from other settings. These studies indicate that frailty is more frequent (≥ 30%) in primary care and outpatient settings, reaching more than 50% of inpatients in hospital wards and over 60% of residents in long-term care facilities (Theou et al., 2018). Not all JAHEE JA Members States (MS) are equally represented in these frailty prevalence studies. Most of the studies reviewed were conducted in just five countries (France, Germany, Italy, the Netherlands and Spain), while another five (Bulgaria, Croatia, Cyprus, Lithuania and Malta), to the best of our knowledge, do not have any published information available (Rodríguez-Laso et al., 2018).
The process of frailty can potentially be prevented and treated, particularly if interventions occur early. Therefore, it is important to know how to manage older adults with frailty or those at risk of developing it (Clegg et al., 2013).
JAHEE is a Joint Action (JA), co-founded by the European Commission under the third EU Health Programme 2014-2020, with 22 MS and 35 organizations involved. Partners worked together to summarize the current state of the art of the different components of frailty and its management, both at a personal and population level, and to increase knowledge in the field of frailty to build a common understanding of frailty to be used by the MS.
The final output of the project was intended to be the “Frailty prevention approach”, a common European model to tackle frailty and indicate what should be prioritized in the upcoming years at European, national and regional level and on which to base a common management approach of older people who are frail or at risk of developing frailty in the European Union. The identification of the core components of frailty and its management should promote the needed changes in the organization and implementation of health and social systems.
JAHEE JA addresses a) policy makers involved in planning and developing health and social care policies and strategies for older people, b) health and social care professionals c) formal and informal carers, who implement the necessary changes in everyday practice and
d) people, those who are frail, those at risk of frailty, as well as the EU population at large (JAHEE JA, 2017).
The present European Guide for Management of Frailty at Individual Level (referred to below as ‘European Guide’) summarises the work of work package 6 – “Management of frailty at individual Level”. This guide focuses on six key fields of intervention that must be taken into consideration when managing frailty, namely: prevention, clinical management, nutrition, physical exercise, medicines, and information and communication technologies (ICTs).