Managing Frailty. A comprehensive approach to promote a disability-free advanced age: the ADVANTAGE initiative
ADVANTAGE will build a common understanding on frailty to be used by Member States on which to base a common management approach of older people who are frail or at risk for 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 the implementation of the Health and Social Systems to provide those models of care that, stemming from the particular health profile of each Member State (MS), will allow them to face the challenge of frailty within a common framework.
ADVANTAGE will summarise the current State of the Art for the different components of frailty and its management, both at individual and population level, will collect information on the development of programs to manage frailty in older adults in the EU and will propose, as its main outcome, a common European model to approach frailty. This model will include a road map that, considering the degree of frailty policies� development, will propose interventions for frail and at risk people and will establish tailored milestones for each MS in order to achieve a comprehensive approach to promote a disability-free advanced age. Furthermore, the model will identify gaps of knowledge in the field that would benefit from further research.
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Our purpose is to critically reduce the burden of frailty in Europe by assisting those partners within the European Innovation Partnership for Active Healthy Ageing (EIPAHA) with commitments focusing on early diagnosis/screening and/or management of frailty to achieve scalability. We have selected EIPAHA because it constitutes a critical instrument for the EU and because it composes the widest representation of initiatives about frailty in Europe.
Our project offers both a service and a network. The service consists of evidence-based guidelines to critically help the selected group of partners to satisfactorily achieve their goals. The network intends to prolong the service in the long term.
To achieve that purpose (WP4) we will define the roadmap, in that we will i) describe the state of art (review of the scientific literature), ii) get a picture of the status of the affected commitments within EIPAHA (barriers, enablers, etc.), and iii) obtain information of the needs of stakeholders. With this real-world landscape in hand, WP5 will define indicators and use a scientifically sound method, comparative effectiveness research, to draw conclusions regarding the most adequate and customized approach to assist commitments in achieving success. Inequalities, cultural conditions or cross-border issues will be considered as representative of the diversity in Europe. Guidelines and toolkits will be issued with the perspective of sustainability. WP6 will constitute the “Platform for Knowledge Exchange” (PKE), which will both facilitate and perpetuate exchange between partners and stakeholders to achieve synergies and guide progression. PKE will act as a repository and as an instrument for dissemination too. WP7 will be a practical test to verify the usability and performance of guidelines in real EIPAHA commitments.
Relevance derives from the wide prevalence of frailty in Europe, consistently the focus throughout the work programme.

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General Objective The proposal is promoted by a network of EIP-AHA Italian Reference Sites with the intent to validate and standardize approaches on frailty and multimorbidity by building on the instruments developed with the European Commission Innovation Partnership on Active and Healthy Ageing. Key-partners of the project are mainly EIP-AHA Reference Sites (and AG Coordinators: A1, A3, B3), representing countries from the northern, southern and eastern part of Europe. Methods and Means Proposed actions will support the development, validation and experimentation of a model to improve the detection, prevention and care of frailty and management of multimorbidity in EU countries, providing partners with different approaches to care from which to adopt/adapt their own systems/services. The model will be experimented in selected RS. It will support the development of innovative tools for the prediction of frailty and multimorbidity by level of care, focussing on community based prevention and avoidable hospitalization. It will offer the EC and the MS with instruments for the potential replication of the model/good practices through the EIP-AHA initiative. The involvement of European networks (EUREGHA), and of the International Scientific Research Networks in the field of frailty and disability (IAGG-GARN), will grant necessary scientific support and advocacy for a real EU and international value.Project’s Main Outcomes• A shared model of references on frailty and multimorbidity.• A tool kit for the prediction of frailty and multimorbidity by level of care: Primary care: easy to use tool to assess risks of frailty through the physical function (slow gait speed, others); tools to support the design of information systems and care pathways for the management of chronic diseases. Secondary-tertiary level: identification of methods and instruments to predict multimorbidity. Other tools: instruments for professional’s skills improvement and analysis of costs.
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There is a proved strong evidence of the usefulness of frailty as a predictive factor of relevant undesired outcomes in populations of older adults. Several studies have been published showing the utility of the concept in improving the prognostic accuracy and the prediction of different risks (hospitalization, surgical and non-surgical complications, length of stay, death, incident disability, etc) in emergency departments, cardiac surgery, surgical patients and in patients with cardiovascular disease. These studies have placed the focus in assessing population risk, while the validation process for these instruments as diagnostic or screening tools has been usually neglected.FRAILTOOLS aims to assess the usefulness as screening and diagnosis tools of some selected instruments to detect frailty in both clinical (Hospital and Primary Care) and social (nursing homes) settings, providing diagnostic algorithms clinically sound. Target groups are all of those older adults at risk for frailty (pre-frail) plus those that are frail and are at risk for developing disability. According to the published prevalence of these two conditions, the target population concerned by this project represent around 40-50% of older people older than 65 and 60-70% of people older than 75. Once determined the best tools of screening and diagnosis in different settings of care, we will reach conclusions for this people wherever the level of care they need and currently use. The benefit will expand to the Health Systems and Social Care as it will provide validated instruments that are necessary to provide an appropriate care for older adults by means of a comprehensive, continued, coordinated and integrated care.FRAILTOOLS consortium involves 6 of the most renowned partners in research on ageing and frailty from Spain, UK, Italy, France and Poland, plus the support of a number of highly relevant collaborating stakeholders fully committed with the project.
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