Ageing is one of the biggest challenges that Europe is currently facing (WHO 2015). Demographic trends suggest that there will be an increase in age-related disability and dependence, which will ultimately im-pact not only on the wellbeing of the individuals affected, but also on the sustainability of health and social care systems (Murray and Lopez 2013). Nevertheless, recent data suggests that disability and dependency trajectories can be changed providing the opportunity for older adults to live longer healthy lives (Chris- tensen et al. 2013).

For most older people, the maintenance of functional ability is of the highest importance. Healthy ageing is defined by the World Health Organization (WHO 2015) as the process of developing and maintaining the functional ability that enables well-being in older age. Therefore, identification of conditions preceding the development of disability and dependency is an essential prerequisite to effectively promote healthy age- ing. Among the most important of conditions that contribute to functional impairment is frailty (Gill et al. 2011).

Frailty is an identifiable decline in physiological systems that results in decreased reserves, confers extreme vulnerability to stressors and increases the risk of a range of adverse health outcomes such as dis- ability, institutionalization, hospitalization and death (WHO, 2015). There is evidence that prevention and early management of frailty can avoid many of the major negative health-related outcomes associated with ageing including functional decline and dependency (WHO, 2015). Nevertheless, although addressing frail- ty is a necessary step to enhance healthy ageing, frailty is not currently considered as a public health priority in many European Countries.

Concern over this situation motivated the European Commission (EC) and many of the Member States (MS) to co-fund the first Joint Action (JA) on the prevention of frailty: JAHEE JA. This document, entitled Promoting Healthy Ageing through a Frailty Prevention Approach (FPA), is the synthesis of the ADVAN- TAGE JA Consortium consensus on the optimal approach to prevent and manage frailty at national/regional levels across Europe. The FPA document has been informed by the main sources described below.

A) The State of the Art Report on Frailty (SoAR)

The first step was preparation of The State of the Art Report on Frailty (SoAR) document, which provides an overview of evidence on what works and what does not work in relation to the prevention and management of frailty. The SoAR reported the JAHEE JA systematic reviews of the literature in different aspects of frailty, as well as a scan of EU-funded research projects, good practices and grey literature documents from participating MSs. The results of the SoAR were presented as answers to 11 key questions (see Technical Re- port. Annex 1). It was released in December 2017 and updated during 2019.

B) MS Baseline Situation Report on the Prevention and Management of Frailty

Partners collected information about the approaches (strategies, policies, programmes, actions, unmet needs) related to frailty in the participating MSs and their regions using a specific survey targeting key informants. The collection and analysis of information took place between September 2017 and May 2018 and is includ- ed in Section 2.3 entitled Frailty in the EU and participant MSs.

C) Consensus Meeting December 2018

Consortium MSs, stakeholders and External Advisory Board partners discussed the draft FPA document in December 2018.

D) Roadmaps for action at MS level

Considering their baseline situation and circumstances and using the SoAR as the gold standard, each MS was asked to develop a Roadmap of actions for the next four years to enhance the promotion of healthy age- ing and address frailty. A summary of these roadmaps is included in Section 2.3 (Road Maps for Actions to- wards a FPA) and more extensively in annex 3. Two Consortium meetings identified common actions and activities to be incorporated as recommendations to all MSs.

E) A common framework for policy action

During 2019 the Consortium concluded their work to conceptualise and build the rationale for a common European framework for a frailty prevention and management approach.

The FPA provides guidance on how to strengthen national/regional capacities and accelerate national/re- gional efforts to set up or further develop a frailty prevention policy in any MS to enhance healthy ageing. It is a practical tool to combat the inequities that currently exist in Europe not only between countries but also within them. The FPA offers guidance on approaches to:

  •  Identify national/regional areas of action on frailty and position these within the MS health priorities.
  •  Set national/ regional objectives and deliverables for the specific areas of action.
  •  Implement proven interventions to reduce risk factors for frailty.
  •  Implement proven interventions to manage frailty at public health level.
  •  Implement proven interventions to train the workforce.
  •  Measure progress and results, considering proposed indicators.
  •  Advance action beyond the health sector through multi-sector co-operation.
  •  Promote international collaboration and cooperation across regions within participant MS to transfer and scale-up best practices.

The FPA document is a reference document for any region, country or MS facing challenges of ageing and frailty.