DEMOGRAPHIC TRENDS IN EUROPE
Europe faces particular challenges related to the demographic change and institutions, such as the European Union (EU) and the World Health Organisation (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 philosophy of care and on how this will be delivered in a most efficient way.
According to the 2015 EU Ageing Report the age demographic of the European population will change dramatically over the coming decades, with older people accounting for an increasing proportion. 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. The WHO World report on ageing and health 2015, offers a comprehensive picture of the situation.
NEW PUBLIC HEALTH CHALLENGES
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.
Thus, there is a need to re-shape healthcare systems to better address new public health challenges, particularly the needs of older people. Recent data suggest that the disability trajectory can be changed, providing the opportunity for older adults to live long healthy lives without loss of function.
To face these challenges changing our mind-set from the current health care conceptual framework, to a new one is mandatory. It should be oriented to function instead of to disease, to prevent instead of to react, to care instead of to cure, and to provide continued and integrated care instead of episodic and fragmented care.
As a consequence, 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 providing care and support to prevent functional decline, frailty and disability. Although they are related, there is not a linear relationship between chronic diseases and function, the latter being the main determinant of both the quality and quantity of life of older people.
Frailty is defined as a state of extreme vulnerability to endogenous and exogenous stressors that exposes the individual to a higher risk of negative health-related outcomes usually due to the interaction between progressive age related decline in physiological systems and some chronic diseases and conditions, with consequent decreased functional reserve capacities.
Frailty is not an inevitable consequence of ageing thus, a stronger focus on early screening and diagnosis is needed for early prevention. Frailty needs to be adequately assessed and managed because it is important to recognise it as a distinct condition independent from ageing, from chronic diseases and from disability.
Prevalence of frailty in older persons living in the community is 10% and 44% for pre-frailty. These findings are consistent with data from the biggest European longitudinal study of ageing, the Survey of Health, Aging and Retirement in Europe (SHARE), which included more than 18,000 community-dwelling individuals aged ≥50 years.According to SHARE the prevalence of frailty among participants aged 65 + is 17% (range by country 5%-27%), with figures for pre-frailty of 42% (range by country 35%-60%], and a clear tendency to increase from Northern to Southern Europe.
There is also consistent evidence across studies for (1) an increasing prevalence of frailty with older age with up to 35-50% of those older than 85 years identifiable as frail, (2) for a higher prevalence in women than in men. Frailty has often been found to be associated with unfavourable socioeconomic circumstances including limited education and poverty.
The figures increase dramatically in clinical settings and in some social (home care, nursing homes, residential care) care settings as well. According to preliminary data from the FRAILCLINIC study (a study run in 5 hospitals in Spain, Italy and UK, funded by DG-SANTE), the prevalence of frailty in clinical settings reaches 60% for older people attending emergency wards, 55% for those attending cardiology services, 22% for those undergoing elective surgery and 36% in oncology out-patients.
EUROPEAN ACTION TO TACKLE THE CHALLENGE OF POPULATION AGING AND FRAILTY
In the 2014 document about the challenge of long-term care provision released jointly by the EC and the European Social Protection Committee, early detection and management of frailty is considered one of the main elements of the proactive response to social protection against long term care conditions dependency.
Among other proactive response from MS it mentions “preventive measures to reduce the fast-rising number of older people needing long term care, with a particular focus on prevention of disability and frailty”.
In the 2015 Ageing Report, the EC and the Economic Policy Committee stated that coping with the challenge posed by an ageing population will require determined policy action in Europe, particularly in reforming pensions and health care and long-term care systems. Therefore, the reduction of disability and dependence through appropriate action on the frailty process should be at the forefront of all policies to tackle the challenge of population aging.
Accordingly, scientific societies, Ministries of Health, the EU through its European Innovation Partnership on Active Healthy Ageing (EIP-AHA) and the WHO have proposed several and complementary strategies to tackle this challenge from a public health perspective.
Also to be noted that a number of EU countries have started advancing different strategies, ranging from the development of full programs to local initiatives oriented to tackling frailty and showing promising results. Several scientific organizations and governmental bodies have agreed that there is a need for population-based strategies to screen and target certain groups for frailty.
FRAILTY IN THE PUBLIC HEALTH POLICY AGENDA
Several reasons make frailty an important topic for public health. However, frailty is not yet at the top of the public health agenda.
- Frailty is a frequent condition and the most common one leading to death;
- The process of frailty can potentially be prevented and treated, particularly if intervention occurs early;
- Despite its prevalence, frailty is not recognised as a clinical or diagnostic syndrome, or when recognised it is not frequently recorded in clinical charts.
JAHEE, THE FIRST JOINT ACTION ON FRAILTY PREVENTION
All the above remarks explain why there is an urgent need to develop evidence base support to make frailty a public health priority. The concern for this situation has motivated the EC and the Council of Europe, and many of the MS to address it.
Thus, JAHEE is the first Joint Action (JA) on the prevention of frailty. It is co-funded by the Third European Health Programme of the European Union 2014-2020 and has a budget of 3.5 million €. It involves, 22 Member States and over 33 organizations and will run for 3 years.
The work that JAHEE will implement is particularly relevant in Europe at current time as it will address the demographic change and the associated increasing demands for social and health care from the burden of chronic diseases, frailty, disability and old age, which are a central priority for the EU and its MS.
The European Innovation Partnership on Active and Healthy Ageing (EIP-AHA), launched in the framework of the Europe 2020 Strategy, is one of the EC´s tools to meet Europe´s demographic changes.