Ageing population in Europe and the importance of frailty
Demographic ageing is one of the most serious challenges that Europe is facing (European Commission 2012). 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. Life expectancy at the age of 65 years, and even at 80 years, has increased and is expected to continue increasing beyond 2020 (European Union, 2017).
Older people are at greatest risk of becoming frail and developing disability. These demographic trends suggest that there will be an increase in age-related disability and dependence, which will ultimately impact not only on the wellbeing of the individuals affected but also on the sustainability of healthcare systems (European Commission, 2015).
As a consequence, the models of care should take into account the need to approach older people not just in terms of addressing diseases but also in terms of care and support to prevent functional decline, frailty and disability (Murray et al., 2013).
Despite ongoing controversy over an agreed definition of frailty, it is widely accepted that it is a geriatric syndrome characterized by a diminished physiological reserve of multiple organs, which means increased vulnerability of older people to adverse outcomes such as disability, institutionalization, hospitalization and death (Gill, 2006; Kan et al., 2008; Rodriguez-Mañas et al., 2012).
Frailty is very common with a global weighted prevalence of approximately 11% in people older than 65 years living in the community (Collard et al., 2012).
Frailty has a clear impact on the costs of health services. Recent studies carried out in Germany, France and Spain have determined its costs in older people both in the community and in hospitals. The incremental annual costs range from 1,500 to 5,000 €/person depending upon the level of frailty and the setting of care (community or hospital) (Bock et al., 2016; García-Nogueras et al., 2016; Sirven et al., 2016).
However, since frailty is not an inevitable consequence of ageing, it may be prevented and treated to foster a longer and healthier life. The identification of conditions preceding the development of disability is an essential requisite to effectively prevent it. Among them the most important risk factor is frailty (Gill et al., 2011).
An EU approach to address frailty
The above-mentioned reasons make frailty an important topic for public health at European level.
In this regard, several institutions, such as the European Commission (EC) and the World Health Organization (WHO), are advancing strategies and actions to create awareness about the need to support and care for older people and to build consensus across all sectors of society regarding both the philosophy of care and on how this will be delivered in the most cost-efficient way.
• The European Innovation Partnership on Active and Healthy Ageing (EIPAHA) was launched in 2012 as an EC response to meet Europe´s demographic challenges. Tackling frailty and disability and promoting integrated care are among its priorities. Action Groups on those topics have since contributed significantly to policy debate at the European Union (EU) and to shape new models for screening, treatment and monitoring as well as sharing good practices (European Commission, 2012).
• In the 2014 joint report on adequate social protection for long-term care needs in an ageing society, the Social Protection Committee and the EC agreed that national policy makers should move to an increasingly proactive policy approach, seeking both to prevent the loss of autonomy and thus reduce care demand, and to boost efficient, cost-effective care provision (European Union, 2014).
• The WHO is taking the lead in advocating for a comprehensive public health action on population ageing focusing on supporting action around the new concept of functional ability (WHO, 2015).
Despite these initiatives, frailty is not yet at the top of the public health agenda. There is an urgent need to develop evidence-based support to make frailty a public health priority.
The concern for this situation motivated the EC, the Parliament and many of the Member States (MSs) to co-fund, by the Third European Health Programme of the European Union 2014-2020, the first Joint Action (JA) on the prevention and management of frailty: JAHEE.
The work that JAHEE JA is implementing is particularly relevant in Europe at present as it addresses the demographic change and the associated increasing demands for social and health care from the burden of chronic diseases, frailty, disability and older age, which are a central priority for the EU and its MSs.
Bringing together 33 partners from 22 MSs for three years, this JA involves a wide range of countries and regions with very different health systems, diverse health and social policies and different cultural, social and economic backgrounds. This scenario represents a formidable challenge but also a great opportunity for concerted action resulting in fostering effective and successful policies in frailty prevention and management in the participating MSs.