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.

Demographic ageing is one of the most serious challenges that Europe is facing. Life expectancy at the age of 65 years, and even at 80 years, has increased and is expected to continue increasing beyond 2020. This segment of the population is at greatest risk of becoming frail and developing disability. Nevertheless, recent data suggests that this disability trajectory can be changed, providing the opportunity for older adults to live long healthy lives without loss of function.

As frailty is not an inevitable consequence of ageing, we need a commonly agreed focus on early diagnosis and screening. An emphasis on prevention can reduce the incidence of frailty. Disability can be avoided by detecting and treating frailty at an early stage and preventing potential decline related to malnutrition, lack of adequate physical activity, cognitive deterioration, falls or other problems.

Addressing the demographic change and the associated increasing demands for social and health care from the burden of chronic diseases, frailty, disability and old age is a central priority for the EU and its MSs. There is a need for sustainable and coordinated approaches which explore the potential for prevention and for re-shaping health care provision. ADVANTAGE JA will help progress at EU level in the area of frailty prevention and may facilitate the national development of frailty prevention policies.

MSs´ collaboration and cooperation in this JA to tackle a common public health issue such as frailty, disability and older people’s health care needs could be considered an ‘added value’ model within EU. It will help to avoid scattered actions and duplication of efforts by MSs and will support them through the development of a common framework by sharing information, capacity and expertise to implement frailty prevention policy.


ADVANTAGE JA will build a common understanding on frailty to be used in Member States (MS), which might be the base for a common management both at individual and population level of older people who are frail or at risk for developing frailty across the EU.
The identification of the core components of frailty and its management will promote the needed changes in the organization and implementation of care in the health and social systems to provide the models of care will allow to face the challenge withina common European framework.

To this end, ADVANTAGE JA will summarise the current state of the art of the different components of frailty and its management, both at a personal and population level; will collect information about ongoing programs to address frailty in older adults across the EU and will propose a common European model to prevent and manage frailty and may facilitate the national development of frailty prevention policies.

ADVANTAGE JA will develop the concept of the ‘Frailty Prevention Approach (FPA)’ in health and social care services, by encouraging consensus and developing common frameworks on screening, prevention, assessment and management of frailty throughout the EU.


ADVANTAGE JA responds to the thematic priority 3.5 of Annex I to the Regulation of the 3rd Programme for the Union's action in the field of health 2014-2020 (“Support actions which address health issues in an ageing society, including relevant actions suggested by the European Innovation Partnership on Active and Healthy Ageing in its three themes: innovation in awareness, prevention and early diagnosis, innovation in cure and care and innovation in active ageing and independent living”).

ADVANTAGE JA Consortium ensures pertinent and meaningful geographical coverage by bringing together 35 partners from 22 MSs, with a wide diversity 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 ef

The ADVANTAGE JA implementation process is divided in three phases, depending on the main actions undertaken and the expected results that will be achieved in each of the three years’ timeframe. Thus,

•Phase I (2017), corresponds to background information collection, analysis and rational discussion and drafting of preliminary documents.
•Phase II (2018), corresponds to developing and testing the draft version of the frailty prevention approach (FPA) document.
•Phase III (2019), corresponds to drafting final documents, debating these with participant MSs, and drafting the final framework, roadmaps for FPA and policy recommendations.

The systematic structure of our efforts and ways we will work to implement the objectives for 2017, includes the following activities to be undertaken:
The methods for achieving the objectives of this JA embrace several strategies, activities and outputs that will be delivered over the three years’ timeline. For clarity these are explored in different bullet points, although in the majority of cases they are interlinked and during the process several stages will be simultaneously developed or even overlap.

The activities to be perfomed on 2017 (reporting period 1) are:

•Review of the literature relevant to the topic, both published and grey. to ensure a homogenous approach by all partners a protocol was designed, agreed and will be applied.
•Release a set of different documents which will explain and synthetize the conceptual reasoning supporting the recommended actions, the framework for developing policies and the roadmaps for initiating or following up the FPA.
•Holding meetings and forums. Mainly four different kinds of meetings will take place: Consortium partners (kick-off meeting, held on 19-20 January 2017); meetings with WPs leaders and co-leaders; meetings with national, regional or local stakeholders; and Meetings of the Governance Structure: Steering Committee, General Assembly and Follow-up.
•Expert consultation. Set-up of Expert panel.
•Create awareness and dissemination of results : An “Awareness, dissemination and communication Plan” will be defined.
•Conceptualization and articulation of ideas: Advance the process of development and clarification of concepts with words and examples and arriving at precise verbal definitions. Partner’s intellectual work and debates using their expertise. Agreed sources of information including key stakeholders identified in MS. Ideas will be constructed in light of the need to enhance, re-shape care for ageing population and the EU demographic prospect.

As at the first trimester of the implementation of the JA, the follow interim outputs have been achieved:

•Launching of the ADVANTAGE Joint Action with the Kick off meeting held on Madrid on 19th and 20th of January 2017. A total of 64 participants, representing the 22 Member States and over 40 organizations that form the Consortium attended, as well as invitees from several EU funded projects and representatives from the European Commission (DG SANTE and CHAFEA) and Spanish health authorities. The meeting was devoted to present and discuss the main issues of theJA and to agree on management, contents, procedures and deadlines.
•ADVANTAGE JA Risk Management and Contingency Plan (Deliverable 1.1) which establishes procedures to recover the JA following a disruption or alert of malfunction in respect to the Grant Agreement (GA), the Consortium Agreement (CA) and or the agreed Work Plan.
•Set-up of Governance structure: Steering Committee and General Assembly.
•ADVANTAGE Logo has been designed and is being used systematically in the JA documents and communications.
•Background documents to set-up common criteria to collect and process the information for frailty state of art.

The majority of the expected outcomes for the first trimester according to the GA have been achieved. (see previous section).
The main expected outcome for 2017 will be updated peer-reviewed information on state of the art on frailty prevention in the participant MS. It will answer the following questions: what should be done; the best way of doing it; what are the expected results when changes are implemented; the concepts to be used; the rationale supporting the need of a different approach and management of frailty to the usual approach to CD.

The launching of the JA that took place at the kick-off meeting in Madrid, Spain was covered by the national media in a number of newspapers and professional web-sites,as well as those platforms and digital media related to frailty, chronic diseases, primary health care, technology and older people.

A number of media contacts have been identified for future awareness on frailty issues and communication and dissemination of JA progress.

Regarding the evaluation activities (WP3), a survey was distributed among participants to evaluate the kick-off meeting. The results show a very high satisfaction both with the organisation and the achievements of the meeting.
WP3 is currently elaborating the Evaluation and Quality Plan scheduled by April 2017.