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1Belgian Ministry of Health
Belgian frailty day: opening
Sciensano - 29/04/2019
Pedro FaconSecretary Interministerial Conference Public Health
Director-general Healthcare
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Why frailty matters
1. Demographic trends (ageing population) + increasing demands
2. Chronic conditions & multimorbidity
3. More complex needs (care & coexisting social needs)
4. Frailty is rather common: across Europe, 1/10 aged 65+ years is
‘frail’
5. Average additional costs associated with frailty (when
controlled for ageing and multimorbidity) range from 1,500 to
5,000 €/person per annum depending on the care setting
studied
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What is frailty?
WHO (2015):
“Frailty is a progressive age-related decline in physiological systems that
results in decreased reserves of intrinsic capacity, which confers extreme
vulnerability to stressors and increases the risk of a range of adverse health
outcomes.”
Different perspectives:
1. Clinical (a clinical state or geriatric syndrome)
2. Functional (losses in human functioning, alterations in several domains of
function and reduction of activities)
3. Multidimensional (frailty covers different domains including the physical,
cognitive and psychosocial domains)
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What is frailty?
What it is NOT:
An inevitable part of
ageing
Living with one or more
long term conditions
(although there may be
overlap)
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What is frailty?
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Policies and actions: Europe
Degree of frailty action development in participating member states*
(ADVANTAGE JA)
* Based on 21 member states background frailty situation reports
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Policies and actions: Europe
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Policies and actions: Europe
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Recommended actions towards a frailty
free EU
• Make frailty prevention a public health priority at EU level
• Involve civil society and a wide range of stakeholders
• Esnure policy is both person centred and population focused
• Embed systematic screening to enable timely identification of frail older people
• Offer prevention and early intervention based on CGA to optimise function
• Design and delliver integrated person centred models of support and services
• Support adequate training of the health and care workforce
• Invest in research and evaluation on frailty
• Support adoption of ICT’s and technological solutions
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Modernise models of care towards
integration and person centredness
Policy enablers:
1. Strong political support
2. Legislative frameworks
3. Financial incentives
4. Leadership and support to change the professional culture
5. Screening and risk prediction tools to select frail older
people for interventions
6. Person centred and holistic approaches
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Policies and actions: Belgium
1. Integrated care
From
Fragmented system
Reactive care
Disease-orientedapproach
Medical model
Supply-driven
‘Passive’ patient
To
Integration and continuity of care
Planned, proactive care
People-centredapproach
Multidisciplinary model
Demand-driven
‘Active’ patient
« Change»
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Policies and actions: Belgium
1. Integrated care
12 pilots in progess
2.330.246 inhabitants
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Policies and actions: Belgium
1. Integrated care: key components
Macro
•Integrated policies and frameworks
•Aligned incentives
•“Health in allpolicies”
Meso
•Cross-sector collaboration
•Shared electronicinformation tools
•Change management
Micro
•Person-centred & community basedapproaches
•Case management & care coordination
•Equity andaccessability
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Policies and actions: Belgium
• 03/2019: shared vision by the Interministerial Conference Public Health on case coordination and case management
• Case coordination
• Collaborative process
• Evaluation, planning, alignment, advocacy
• Matching services with needs of the person and her environment
• Through communication and other tools
• Quality and efficency of care
• Lead by a care provider within the care team
• Case management
• Loss of decional autonomy of the person or her environment
• Complexity of care
• Problems within the care team
• Lead by someone outside the care team, on demand of the care team
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Policies and actions: Belgium
2. BelRAI
• Comprehensive assessment instruments
• Functioning and care needs
• Frail persons (complex care processes)
• Provides input for care planning (NO
automatic care plan)
• Uniform use across care settings
• Evidence-based interRAI
General aim = providing qualitative care
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Policies and actions: Belgium
2. BelRAI: available instruments
Residential setting Ambulatory setting Screeners
BelRAI Long Term Care
Facilities
Frail older persons
BelRAI Home Care
Frail persons at home
BelRAI screener
Do the person need a
comprehensive
assessment?
BelRAI Mental Health
Persons with mental health
problems
BelRAI Community Mental
Health
Persons with mental
health problems
BelRAI Palliative Care
Persons with palliative
needs
BelRAI Palliative Care
Persons with palliative
needs
Palliative screener (PICT)
Do the person need a
comprehensive PC
assessment?
BelRAI Acute Care
Frail persons at hospital
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Policies and actions: Belgium
2. BelRAI: advantages
• Holistic view on the functioning of the
client
• Focus on capacity of the client
• Detecting actual and potential points for
attention
• Objective data
• Common language across care
professionals and care settings
• Supports multidisciplinary collaboration
• Supports care continuity
• Evidence based
• …
