Public health and clinical approach to proactive management of frailty in multidimensional arena
Keywords:
Frailty, clinical management, public health, EIPonAHA, person-centredAbstract
Background. Demographic changes have forced communities and people themselves to reshape ageing concepts and approaches and try to develop actions towards active and healthy ageing. In this context, the European Commission launched different private-public partnerships to develop new solutions and answers on questions related to this topic. The European Innovation Partnership on Active and Healthy Ageing, including topic related action groups as well reference sites committed towards a common action to facilitate active and healthy ageing, has contributed key elements for interventions, scaled up best practices and evaluated impact of their action to drive innovation across many regions in Europe over the past years.
Methods. This paper describes action taken by A3 action group in the European Innovation Partnership on Active and Healthy Ageing. This paper gives an overview of how the partnership combined the view on frailty coming from public health as well as the clinical management.
Results. Within different European regions, to tackle frailty, EIPonAHA partners have conceptualized functional decline and frailty, making use of good practice models working well on community programs. The A3 Group of EIPonAHA has worked alongside a process of innovation, targeting all ageing citizens with the clear goal of involving communities in the preventive approach.
Conclusion. Engagement needs of older people with a focus on functionally rather than disease management as primary objective is considered as an overarching concept, also embracing adherence, compliance, empowerment, health literacy, shared decision-making, and activation. Furthermore, training of staff working with ageing people across all sectors needs to be implemented and evaluated in future studies
References
1. Beard JR, Officer A, de Carvalho IA, et al. The World report on ageing and health: a policy framework for healthy ageing. Lancet 2016; 387(10033): 2145-54. doi: 10.1016/S01406736(15)00516-4.
2. Rodriguez Manas L, Garcia-Sanchez I, Hendry A, et al. Key Messages for a Frailty Prevention and Management Policy in Europe from the ADVANTAGE JOINT ACTION Consortium.
J Nutr Health Aging 2018; 22(8): 892-7. doi: 10.1007/s12603-018-1064-y.
3. Sunfrail. Project overview. The sunfrail world. Available on: http://www.sunfrail.eu/ [Last accessed: 2020, Dec 12].
4. European Commission, CORDIS. Personalised ICT Supported Service for Independent Living and Active Ageing. Available on: https://cordis. europa.eu/project/id/610359/it [Last accessed:
2020, Dec 12].
5. European Commission. European Innovation Partnership on Active and Healthy Ageing. A3 Lifespan Health Promotion & Prevention of Age Related Frailty and Disease. Available on: https://ec.europa.eu/eip/ageing/actiongroups-eip-aha/a3-lifespan-health-promotionprevention-age-related-frailty-and-disease_en [Last accessed: 2020, Dec 12].
6. Cano A, Dargent G, Carriazo A, et al. Tackling frailty and functional decline: Background of the action group A3 of the European innovation partnership for active and healthy ageing.
Maturitas 2018; 115: 69-73. doi: 10.1016/j.
maturitas.2018.06.009. Epub 2018 Jun 20.
7. Liotta G, Ussai S, Illario M, et al. Frailty as the Future Core Business of Public Health: Report of the Activities of the A3 Action Group of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA). Int J Environ Res Public Health 2018; 15(12): 2843. doi: 10.3390/ ijerph15122843.
8. Illario M, Maione AS, Rusciano MR, et al. NutriLive: An Integrated Nutritional Approach as a Sustainable Tool to Prevent Malnutrition in Older People and Promote Active and Healthy Ageing - The EIP-AHA Nutrition Action Group. Adv Public Health 2016; 2016: 9. doi. org/10.1155/2016/5678782.
9. Gustaffson T, Ollila M. Expert Consultation in the Preparation of a National Technology Programme. Available on: https://sal.aalto.fi/publications/pdf-files/mgus03a.pdf [Last accessed: 2020, Dec 23].
10. Martin TG, Burgman MA, Fidler F, et al. Eliciting expert knowledge in conservation science. Conserv Biol 2012 Feb; 26(1): 29-38. doi: 10.1111/j.1523-1739.2011.01806.x.
11. European Commission. European Innovation Partnership on Active and Healthy Ageing. Action Group Meeting A3: Action for Prevention of Functional Decline and Frailty 2013. Available on: https://ec.europa.eu/eip/ageing/events/ action-group-meeting-a3-action-preventionfunctional-decline-and-frailty_en) [Last accessed: 2020, Dec 12].
12. World Health Organization (WHO). World report on ageing and health. Geneva, Switzerland: World Health Organization, 2015. Available on: https://www.who.int/ageing/events/worldreport-2015-launch/en/. [Last accessed: 2020, Dec 12].
13. Gobbens RJ, Luijkx KG, Wijnen-Sponselee MT, Schols JM. Toward a conceptual definition of frail community dwelling older people. Nurs Outlook 2010; 58(2): 76-86. doi: 10.1016/j.
outlook.2009.09.005.
14. Morley JE, Vellas B, van Kan GA, et al. Frailty consensus: a call to action. J Am Med Dir Assoc 2013; 14(6): 392-7. doi: 10.1016/j. jamda.2013.03.022.
15. Junius-Walker U, Onder G, Soleymani D, et al. The essence of frailty: A systematic review and qualitative synthesis on frailty concepts and definitions. Eur J Intern Med 2018; 56: 3-10. doi: 10.1016/j.ejim.2018.04.023. Epub 2018 May 31.
16. Pamoukdjian F, Paillaud E, Zelek L, et al. Measurement of gait speed in older adults to identify complications associated with frailty: A systematic review. J Geriatr Oncol 2015; 6(6): 484-96. doi: 10.1016/j.jgo.2015.08.006. Epub 2015 Sep 9.
17. Freiberger E, de Vreede P, Schoene D, et al. Performance-based physical function in older community-dwelling persons: a systematic review of instruments. Age Ageing 2012; 41(6): 712-21. doi: 10.1093/ageing/afs099. Epub 2012 Aug 10.
18. Folstein MF, Folstein SE, McHugh PR. “Minimental state”: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12(3): 189-98. doi: 10.1016/0022-3956(75)90026-6.
19. Dent E, Visvanathan R, Piantadosi C, Chapman I. Use of the Mini Nutritional assessment to detect frailty in hospitalised older people. J Nutr Health Aging 2012; 16(9): 764-7. doi: 10.1007/ s12603-012-0405-5.
20. Ellis G, Langhorne P. Comprehensive geriatric assessment for older hospital patients. Br Med Bull 2005; 71(1): 45-59. doi: 10.1093/bmb/ ldh033.
21. Ellis G, Gardner M, Tsiachristas A, Langhorne P, et al. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database of Systematic Reviews 2017(9).
22. Hirdes JP, Ljunggren G, Morris JN, et al. Reliability of the interRAI suite of assessment instruments: a 12-country study of an integrated health information system. BMC Health Serv Res 2008; 8(1): 277. doi: 10.1186/1472-69638-277.
23. van de Pol MHJ, Fluit CRMG, Lagro J, Slaats YHP, Olde Rikkert MGM, Lagro-Janssen ALM.
Expert and patient consensus on a dynamic model for shared decision-making in frail older patients. Patient Educ Couns 2016; 99(6): 106977. doi: 10.1016/j.pec.2015.12.014. Epub 2015 Dec 28.
24. Advantage Joint Action. Promoting healthy ageing through a Frailty Prevention Approach. ADVANTAGE JA Secretariat, 2019. Available on: https://advantageja.eu/images/FPA-CoreADVANTAGE-doc.pdf [Last accessed: 2020, Dec 12].
25. Buckinx F, Rolland Y, Reginster JY, Ricour C, Petermans J, Bruyère O. Burden of frailty in the elderly population: perspectives for a public health challenge. Arch Public Health 2015; 73(1): 19. doi: 10.1186/s13690-015-0068-x. Epub 2015 Apr 10.
26. Goldblatt P, Siegrist J, Lundberg O, Marinetti C, Farrer L, Costongs C. Improving health equity through action across the life course: Summary of evidence and recommendations from the DRIVERS project. Report produced as part of the ‘DRIVERS for Health equity’ project. Brussels: EuroHealthNet., 2015.
27. Jacobzone S. Ageing and Care for Frail Elderly Persons: An Overview of International Perspectives. OECD Labour Market and Social Policy. Occasional Papers No. 38. Paris: OECD,1999. https://doi.org/10.1787/313777154147. Available on: https://www.oecd-ilibrary.org/content/ paper/313777154147 [Last accessed: 2020, Dec 12].
28. Roller-Wirnsberger R, Thurner B, Pucher C, Lindner S, Wirnsberger GH. The clinical and therapeutic challenge of treating older patients in clinical practice. Br J Clin Pharmacol 2019: 10.1111/bcp.14074. doi: 10.1111/bcp.14074. Epub 2019 June 19.
29. Bevc CA, Retrum JH, Varda DM. New perspectives on the “silo effect”: initial comparisons of network structures across public health collaboratives. Am J Public Health 2015 Apr; 105; 2(Suppl 2): S230-5. doi: 10.2105/ AJPH.2014.302256. Epub 2015 Feb 17.
30. McCullough JM, Leider JP, Phillips MA. Integration of Health and Social Services at the Systems Level: A Framework for Addressing Funding and Jurisdictional Silos. Am J Public Health 2020 Jul; 110(S2): S197-S203. doi: 10.2105/AJPH.2020.305735.
31. Kaufman NJ, Castrucci BC, Pearsol J, et al. Thinking beyond the silos: emerging priorities in workforce development for state and local government public health agencies. J Public Health Manag Pract 2014 Nov-Dec; 20(6): 557-65. doi: 10.1097/PHH.0000000000000076.
32. Theou O, Searle SD. Using frailty tools as prognostic markers in patients who are acutely ill. CMAJ 2018; 190(7): E182-3. doi: 10.1503/ cmaj.170902.
33. Gilardi F, Scarcella P, Proietti MG, et al. Frailty as a predictor of mortality and hospital services use in older adults: a cluster analysis in a cohort study. Eur J Public Health 2018; 28(5): 842-6. doi: 10.1093/eurpub/cky006.
34. Regulation (EU) No 282/2014 of the European Parliament and of the Council of 11 March 2014 on the establishment of a third Programme for the Union’s action in the field of health (20142020) and repealing Decision No 1350/2007/ EC, 2014.
35. Rockwood K, Blodgett JM, Theou O, et al. A Frailty Index Based On Deficit Accumulation Quantifies Mortality Risk in Humans and in Mice. Sci Rep 2017; 7: 43068. doi: 10.1038/ srep43068. Epub 2017 Feb 21.
36. Cesari M, Gambassi G, Abellan van Kan G, Vellas B. The frailty phenotype and the frailty index: different instruments for different purposes. Age Ageing 2013; 43(1): 10-2. https:// doi.org/10.1093/ageing/aft160. Epub 2016 Oct 13.
37. García-García FJ, Carcaillon L, Fernandez-Tresguerres J, et al. A New Operational Definition of Frailty: The Frailty Trait Scale. J Am Med Dir Assoc 2014; 15(5): 371.e7-13. doi: 10.1016/j.
jamda.2014.01.004. Epub 2014 Mar 2.
38. Platzer E, Singler K, Dovjak P, et al. Evidence of Inter-professional and multi-professional interventions for geratric patients: a Systematic Review. Int J Integr Care 2019; 20(1): 6. doi: 10.5334/ijic.4683.
39. Liotta G, Inzerilli MC, Palombi L, et al. Social Interventions to Prevent Heat-Related Mortality in the Older Adult in Rome, Italy: A Quasi-Experimental Study. Int J Environ Res Public Health 2018; 15(4): 715. doi: 10.3390/ijerph15040715.
Epub 218 Apr 11.
40. Liotta G, Inzerilli MC, Palombi L, et al. Impact of social care on Hospital Admissions in a sample of community-dwelling older adults: results of a quasi-experimental study. Ann Ig 2018; 30(5): 378-86. doi: 10.7416/ ai.2018.2237.
41. Bousquet J, Illario M, Farrell J, et al. The Reference Site Collaborative Network of the European Innovation Partnership on Active and Healthy Ageing. Transl Med UniSa 2019; 19: 66-81. Epub 2019 Jan 6.
42. van Velsen L, Illario M, Jansen-Kosterink S, et al. A Community-Based, Technology-Supported Health Service for Detecting and Preventing Frailty among Older Adults: A Participatory Design Development Process. J Aging Res 2015; 2015: 216084. doi: 10.1155/2015/216084. Epub 2015 Aug 5.
43. Longobucco Y, Benedetti C, Tagliaferri S, et al. Proactive interception and care of Frailty and Multimorbidity in older persons: the experience of the European Innovation Partnership on Active and Healthy Ageing and the response of Parma Local Health Trust and Lab through European Projects. Acta Biomed 2019; 90(2): 364-74. doi: 10.23750/abm. v90i2.8419.
44. VIGOUR. Evidence-based guidance to scale-up integrated care in Europe. Available on: https:// vigour-integratedcare.eu/ [Last accessed: 2020, Dec 12].
45. Maggio M, Barbolini M, Longobucco Y, et al. A Novel Tool for the Early Identification of Frailty in Elderly People: The Application in Primary Care Settings. J Frailty Aging 2020; 92(2) 101-6. doi: 10.14283/jfa.2019.41.
46. Roller-Wirnsberger R, Lindner S, Liew A, et al. European Collaborative and Interprofessional Capability Framework for Prevention and Management of Frailty—a consensus process supported by the Joint Action for Frailty Prevention (ADVANTAGE) and the European Geriatric Medicine Society (EuGMS). Aging Clin Exp Res 2020; 32(4): 561-70. doi: 10.1007/s40520019-01455-5. Epub 2020 Jan 22.
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.