The Action on

TheActionGroup

onFrailty

Story2012-2014

Part of the European Innovation Partnershipon Active and Healthy Ageing

AcknowledgementsThis report has been prepared by the European Commission, Directorate General for Health andConsumers, Unit 02: Innovation for Health and Consumers, led by Jorge Pinto Antunes. Ines García-Sánchez and Anna Carta where responsible for the drafting in collaboration with the coordinators andtask facilitators of the European Innovation Partnership on Active and Healthy Ageing, Frailty ActionGroup, who stimulated and followed-up di�erent activities of the common work and responded to allour queries.Michael Veale has been responsible for the graphical editing of the manuscript.

Disclaimer

By the European Commission.

The information and views set out in this publication are those of the authors and do not necessarilyre�ect the o�cial opinion of the Commission. The Commission does not guarantee the accuracy ofthe data included. Neither the Commission nor the Action Groups may be held responsible for the usewhich may be made of the information contained therein.

© European Union, 2014. All rights reserved. Certain parts are licensed under conditions to the EU.

Reproduction is authorised provided the source is acknowledged.

Cover picture © iStock.

Executive Summary

The European Innovation Partnership on Activeand Healthy Ageing (hereafter EIP AHA, or thePartnership) was launched in 2012 as a Commis-sion response to demographic changes in the EU.Three years since it was launched, the Partnershipis helping to identify and develop new approachesfor supporting change, placing patients at the cen-tre of health and social care systems, and mov-ing away from hospital-centred, reactive, disease-focused care, and instead towards a proactive, com-munity based model of prevention and continu-ous care management, with the participation ofthe patient and informal care-givers. Furthermore,health and care services supported by ICT systemscan provide alternative ways for better and moretargeted care and more e�cient use of resources.The Action Group on Prevention and Early Diag-nosis of Frailty and Functional Decline, which in-cludes both physical and cognitive decline, in olderpeople (henceforth referred to as Frailty group)wascreated in June 2012 as part of the EIP on AHA.Its aim is to facilitate the work of stakeholders aim-ing to improve the current situation and achieve asupportive organisational context that can remedythe problems of everyday life and clinical practiceencountered by frail older people and their care-givers.

Their objectives and activities address the chal-lenges that fall in any of the following domains:Frailty in general; Cognitive decline; Functionaldecline; Nutrition; Care givers and Dependency;and Physical activity.

It is not easy to disentangle the speci�c impactof the frailty group itself, but it is important thatdi�erent European, national and regional initia-tivesmove in the same direction and build up a crit-

ical mass in the areas of most importance. In thisrespect, framing the idea of the “frailty preventionapproach” has been the most fundamental out-come of the work done by the Frailty group. Un-dertaking actions on advocacy, screening, researchand coordination of care, they have contributedto establishing a common European approach totackle frailty in older people. Furthermore, someof their preliminary results, and the collection ofgood practices can be a source of inspiration forfurther management improvement and policy de-velopment.

This booklet aims to o�er an overview of thefrailty group process, starting from the reasonsthat urged the creation of the group until the cur-rent organisation. In the second part the resultsachieved so far will be analysed. We have chosen topresent them following the same logic that appliesto the frailty group work structure:

• Individual commitmentdeliverables’ results

• Collaborative work achievements

In the coming years e�orts aimed at raising ef-fectiveness of care delivery will be crucial. Workingclosely and sharing ideas and solutions can help theEuropean Union (EU) as a whole to �nd and im-plement new strategies to tackle frailty. The frailtygroup can play a fundamental role in building anEU policy on frailty prevention. This report exam-ines its work process and experiences and pointsout how it can contribute to it.

1

Contents

Contents 2

1 The demographic change in Europe and the EIP AHA 3

2 The Action Group on frailty prevention (frailty group) 52.1 The role of the frailty Action Group . . . . . . . . . . . . . . . . . . . . . . . . . 52.2 The structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52.3 Governance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62.4 Work development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Yammer platform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8AGMeetings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8TheMarketplace . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8The Conference of Partners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

3 Actions of the Frailty Group by Domain 93.1 Advocacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93.2 Screening & Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93.3 Care management & assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . 93.4 Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

4 What has been achieved? 104.1 General outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104.2 Speci�c deliverables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Individual commitments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Common work and deliverables . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

5 Conclusions and the way forward 14

6 Appendix of deliverables and annexes 15

2

1The demographic change inEurope and the EIP AHA

Demographic ageing is one of the most seriouschallenges Europe is facing. Supporting active andhealthy ageing is important both to improve thequality of life of elderly citizens and help them con-tribute to society as they grow older; and to reduceunsustainable pressure on health systems. The Eu-ropean Commission (hereafter EC or the Commis-sion) has launched, among other initiatives, theEuropean Innovation Partnerships within the In-novation Union, one of the �agship initiatives ofthe Europe 2020 strategy, with the objective ofaccelerating innovation to address a well-de�nedtarget within a grand societal challenge. The ECidenti�ed active and healthy ageing as a major soci-etal challenge common to all EUMember States(MS), and as an area presenting considerable poten-tials for Europe to act as a global leader inprovidinginnovative responses.

The EIP on AHA is one of the Commission’sanswers to the demographic challenges that Eu-rope is facing, under the framework of Europe2020 strategy. It sets a target of increasing thehealthy lifespan of EU citizens by 2 years by 2020,and aims to pursue a triple win for Europe by im-proving the quality of life of older people and en-able them to stay active for longer, through activeageing and independent living; improving the sus-tainability and e�ciency of social and health caresystems; and the enhanced competitiveness of Eu-ropean industry through new markets and busi-ness expansion. The Partnership is neither a newfunding programme or instrument nor a new le-gal entity, and does not replace existing decision-making processes.

The EIP AHA re�ects a growing awarenessthat better care and sustainability of health ser-

vices calls for innovative ways to address the needsof the elderly. It has encouraged a wide range ofstakeholders to join forces, to improve coopera-tion, and to foster political commitment, so as toencourage innovative solutions towards a betterquality of life as citizens grow older. It identi�ed aset of actions that could start as early as 2012 anddelivermeasurable outcomeswithin the 2012-2015timeframe.

The Strategic Implementation Plan (SIP) thatwas adopted by the Partnership’s Steering Groupin November 2011, focuses on actions developedaround 3 pillars: A) prevention, screening andearly diagnosis; B) care and cure; and C) activeageing and independent living. Within each pillar,it sets out a limited number of speci�c actions tobe implemented from 2012. These thematic pil-lars are complemented with a set of cross-cuttingpriorities, such as framework conditions, evidenceand funding.

About frailtyFrailty is a complex syndrome ofincreased vulnerability, determinedby life course events, social andpsychological environments. Itrequires timely interventions.Because frailty is not an inevitableconsequence of ageing, we need astronger focus on early diagnosisand screening.An emphasis on prevention canreduce the incidence of frailty andpostpone its onset.

3

CHAPTER 1. THEDEMOGRAPHIC CHANGE IN EUROPE ANDTHE EIP AHA 4

The partners involved in the EIP AHA areorganised in six Action Groups (AG) created inJune 2012. These groups have agreed action planswith concrete activities, deliverables, objectives, re-sources and timeframe to implement successfullythe speci�c actions. They focus on collaborativeprocess of sharing information and solutions onhow to overcome a bottleneck, undertaking ac-tions together andbrainstorming together towardsshared goals. They were built up on the basis oftwo calls for commitment launched by the Euro-pean commission on 2012 and 2013; in total morethan 500 commitments were submitted from upto 300 leading organisations actively forming coali-tions and consortia, covering stakeholders from allEUMS.

One of these six AGs is Action Group on pre-vention of frailty, the frailty group, which aimsto improve the current situation and achieve asupportive organisational context that can remedythe problems of everyday life and clinical practiceencountered by frail older people and their care-givers.

2The Action Group on frailtyprevention (frailty group)

2.1 The role of the frailty Ac-tion Group

Under pillar on Prevention of the SIP, an Actionon "implementing integrated programmes for pre-vention, early diagnosis and management of func-tional decline, both physical and cognitive, in olderpeople" was identi�ed and ready to start in 2012.The partners who responded to the call committedto the following actions. See Box 1.

2.2 The structure

After the two rounds of calls for commitments,160 partners expressing a total of 131 commitments,started working together in this multidisciplinaryaction group. It brings together public health au-thorities, care organisations, academia, researchcentres, industries, patients associations and pro-fessional bodies from across most European coun-tries. See Figure 2.1 showing type of stakeholdersinvolved. A list of partners is presented in the an-nex.

These partners have committed themselves toimplementing innovative solutions to better un-derstand the underlying factors of frailty, to ex-plore the association between frailty and adversehealth outcomes in older people and to better pre-vent and manage the frailty syndrome and its con-sequences.

Their shared principles are:

• To put older people in need of health andcare services at the centre of their work.

Figure 2.1: Structure of the Action Groupby type of Partner

AdvocacyOrganisations

LargeIndustry

Other

Private HealthProvider

Public HealthProvider

Public UniversityHospital

RegionalAdministration

Research/Academia

SME

0 20 40 60Count

Call First Second

• To work in alliance, sharing a common pur-pose, across the health and social care systemin numerous EU countries.

• To commit to the Partnership’s goal of 2healthy life years.

This AG’s purpose is to provide older peoplewith safe, e�ective, compassionate, high-qualitycare and to encourage care services to improve inthis regard by tackling frailty. Their role is to ex-change ideas and experiences, to disseminate their

5

CHAPTER 2. THE ACTIONGROUPON FRAILTY PREVENTION (FRAILTY GROUP) 6

Figure 2.2: Action Group structure according to the frailty subdomains.

Frailty in GeneralCo-ordinator

Leocadio Rodriguez MañasHospital Universitario de Getafe,

Madrid, Spain

Cognitive DeclineCo-ordinator

Antonio CanoUniversity of Valencia, Spain

Functional DeclineCo-ordinator

Roberto BernabeiUniversità Cattolica del Sacro Cuore,

Rome, Italy

NutritionCo-ordinator

Maddalena IllarioUniversity of Naples Federico II, Italy

Caregivers & DependencyCo-ordinator

William MolloySt. Finbarr’s Hospital, University College

Cork, Ireland

Physical ActivityCo-ordinatorMiren David

KRONIKGUNE, País Vasco, Spain

Figure 2.3: Significant Action Group milestones.

ConferenceEIP on AHA: from

Plan to Action

1st Conferenceof Partners

Delivering resultsfor Europe

1st FrailtyConference

Frailty in old age:A public concern

at EU level

2nd Conferenceof Partners

Scaling up forhealth and

growth

2nd FrailtyConference

Frailty in old age:Identifying priorities

for an EU policy

3rd Conference of Partners

Taking stock andfocusing on

delivery

SIP target by 2015Validated programme

for prevention of functionaldecline and frailty among

older people, supported bytools, networks & information

2012 2013 2014

AG meeting #1

AG meeting #2

AG meeting #3 AG meeting #4

AG meeting #5

AG meeting #6

AG meeting #7

Good practices booklet producedCall for

Commitments 1

Call for Commitments 2

work, to implement their individual commitmentsand common work and, by doing so contribute tothe aims and objectives of the EIP AHA.

The collective e�orts of the frailty groupmem-bers is an expression of the shared vision as part-ners of the EIP, contributing with their work toimprove the current situation and achieve a sup-portive organisational context that can remedy theproblems of everyday life and clinical practice en-counteredby frail older people and their care-givers.

The frailty group structure as well as their ob-jectives and activities is organised around 6 topics.The group ambition is to add their voice and criti-cal mass to push the frailty prevention approachtowards is tipping point in the following domains:

1. Frailty in general

2. Functional decline

3. Cognitive decline

4. Nutrition

5. Care givers and dependency

6. Physical activity

2.3 Governance

To ensure the delivery of actions set up in the SIPthe Commission puts in place a simple and �exiblegovernance structure where AGs established theirworking ownmethods and governance, with theCommission facilitating the process. The Commis-sion organises a Conference of Partners, gatheringcommitted and involved Partnership stakeholders,on an annual basis as from end 2012 to discuss anddecide on the issues related to the Plan’s implemen-tation, future actions and governance.

More details about governance of the groupcan be found in the annexes.


Box 1: Role of the frailty action group actions according to the SIP

1. The area to be addressed: "Prevention and early diagnosis of frailty andfunctional decline, both physical and cognitive, in older people".

2. The following actions to be launched:

• Shift the approach from reactive disease management to screening, triage,anticipatory care and prevention of functional decline. This shift is to bebrought about through innovative, coordinated and comprehensivecommunity based prevention, assessment and integrated casemanagement systems delivered within an integrated health and caresystem.

• Develop and implement early diagnosis and screening programmes forselected conditions that are associated with functional decline, eg.cardiovascular disease, dementia and osteoporosis.

• Where dementia is diagnosed, define an optimal approach for the supportof caregivers and older people with dementia.

• Where physical problems related to functional decline and frailty arediagnosed, solutions for optimal treatment will be used.

• Validate programmes to prevent functional decline and frailty, focusing onnutrition, physical activity and cognitive impairment in older people.

• Develop tools, networks and information to support these programmes toreach at least 1000 care providers across the EU.

• Create a functional capacity evaluation tool for active ageing in theworkplace which could help establish synergies/ fit between capabilitiesand workload.

2.4 Work development

The Frailty Group is currently implementing anagreed common Action Plan. It was based on theobjectives, activities, timing and deliverables spec-i�ed in the commitments sent in by a group ofstakeholders. This Action Plan frames the work tobe applied by all partners who adhere to this groupand a more operational work plan and roadmapfor 2014-2015 is in place.

A diagram with the milestones for the 2012-2014period towards the SIP target by2015 is shownin Figure 2.3.

The Action Plan partners’ work mainly fol-lows 2 parallel and complementary strands:

• Individual commitment The �rst strand re-gards what partners have committed to pro-

duce in the coming years as result of their in-dividual commitments promised to developwhen they joined the Partnership. Their ac-tivity focuses on the work that each partnerperforms on its own setting. The EC fol-lows up on this as part of the monitoringprocess, and comes back to partners regu-larly to understand further the state of playin the implementation process.

• Collaborative work The second strand re-gards the collaborative work among part-ners building on domains which are com-mon to several individual commitments, witha view to achieve additional results with re-spect to those set individually in their respec-tive commitments.


Strategic implementation plan(SIP) target“implementing integratedprogrammes for prevention, earlydiagnosis and management offunctional decline, both physical andcognitive, in older people”

The strength of their work within the Part-nership is that every member contributes to theachievement of common objectives. On the samewavelength, together they explore common solu-tions for the key challenges related to frailty, physi-cal decline, cognitive decline as well as risks factorssuch as malnutrition or lack of physical activity forolder people.

Both strands focus on certain areas where ac-tions related to frailty have to advance such as ad-vocacy, care management and assessment, and re-search. They are summarised in the next section.

In addition to this, a wide variety of di�erenttools to support work implementation are in place.

Yammer platformA collaborative platform called “Yammer” is themain communication tool among the Commis-sion the Frailty group partners; documents andfollow-up news are regularly posted on it. It isalso the place to post individual comments andfollow-up discussions among the group members.Partners are invited to use it as much as possibleto exchange information, comments, documents,and anything else that could be useful to the activ-ities of the Group.

AG MeetingsAt least twice a year, partners are invited to at-tend meetings in Brussels. Two group meetingsare scheduled yearly. The main objectives are theexchange of information according to the agreedagenda between the Commission and the Partners,and the reinforcement of the AG dynamic.

No �nancial aid is available for attending thesemeetings

The MarketplaceTheMarketplace is an online platform for informa-tion about the Partnership and to help exchangeviews, �nd partners for speci�c projects or for in-teraction among the partners and outside stake-holders interested in the topic.

The Conference of PartnersThe Conference of Partners is a gathering eventorganised by the Commission on an annual ba-sis to discuss and decide on issues related to theimplementation of the action plans and future ac-tions. Between 2012 and 2013, three Conferencesof Partners have been held in Brussels.

How to reach the SIP target?

• Developing individualcommitments in action groupsand incorporating new partnersthat fill in identified gaps.

• Peer-review validation ofcommon work deliverables andmaking them accessible to EIPAHA partners and the widerpublic.

• Open the process toincorporate new interventions,good practices and newevidence into the action groupwork.

• Find support from theCommission to facilitate aprocess that allows coachingbetween partners’ experiencesand sharing outcomes.

• Access to funding to supportproject proposals and ongoingactivities.

3Actions of the Frailty Group byDomain

This section summarises the main actions of thefrailty group, ordering them by the domain inwhich they fall.

3.1 Advocacy

• Informing the opinion on frailty interven-tions at levelswherepriorities are determinedand decisions are taken.

• Bringing attention to the issue of frailty inolder people being a common EU publichealth problem.

3.2 Screening & Prevention

• Preventing occurrence of frailty and avoid-ing its predictable negative consequences.

• Preventing factors, such as malnutrition orlack of regular physical activity, which haveimpact ondi�erent components of the frailtysyndrome.

• Supporting adequate nutrition and physicalactivity.

• Prevention, screening and early assessmentof risk factors.

3.3 Care management & as-sessment

• Supporting evidencebased interventions throughappropriate pathways of health and socialcare to avoid frailty, its progression to dis-ability and its negative consequences.

• Diminishing avoidable and recurrent hospi-talizations.

• Trainingprofessionals to improve their knowl-edge and skills andkeeppacewithnewneeds.

• Supporting care-givers in their tasks of car-ing for their dependant relatives.

• Identifying those patients whose outcomeshave the higher costs for the health system.

• Identifying thosemost at risk and thosewhowill bene�t most from the interventions.

• Supporting a multi-disciplinary approachto care and management.

• Evaluating current interventions, and sup-porting what really works.

• Supporting care and preventive interven-tions that can be delivered within the com-munity.

• Sharing good practices ready to scale up.• Implementing guidelines to improve man-agement and prevention of frailty.

3.4 Research

• Finding solutions to new challenges.• Looking for new and e�cient ways of solv-ing old problems.

• Improving methodology for the screeningand identi�cation of pre-frail status.

• Basic research development on any of thesix content domains of frailty.

9

4What has been achieved?

4.1 General outcomes

In almost 3 years of collaboration the AG partnershave managed to establish a common approachto provide older people with safe, e�ective, com-passionate, high-quality care and to encourage careservices to improve in this regard by tackling frailtyin older people. Although the activities are still inearly stages, the action group has already achievedsome results, such as:

• Amore comprehensive and clear understand-ing of frailty and its priorities. The exchangeof knowledge and expertise among partnershas resulted in the identi�cation of clearbenchmark on 6 main areas of intervention:frailty in general, physical decline, cogni-tive decline, nutrition, dependency and caregivers, physical activity.

• Contribution to the policy debate at EU level,providing technical inputs to theECon frailtyand functional decline in particular throughthe international conferences on frailty or-ganised by the Commission. OnApril 2013,an international conference on frailty in oldage, addressing the issue from the perspec-tive of a public health concern for the EUand in 18th June 2014, a second one focus-ing on identifying priorities for an EU pol-icy on frailty. Both conferences have beenuseful to give visibility to the work of thefrailty group and building up the supportof the convenience of addressing frailty pre-vention at EU level.

• More reliable trials, many partners had theopportunity to test their protocols and tools

in broader settings, allowing strengtheningthe reliability of both protocols and tools.(e,g: see deliverables from sub-group em-powerment and care-givers)

• Shaping a new model for screening, treat-ment and monitoring of frailty and func-tional decline in community and clinical set-tings. (eg: See deliverables of sub-group onfrailty and physical decline)

• A more suitable training o�ering for health-care professionals. Di�erent groupmembershave proposed improved training coursesfor nurses, social workers and PhD studentson frailty topics. (e.g: see speci�c individu-als commitments annex)

• A collection of good practices in frailty pre-vention. The �nal text gathers 98 good prac-tices coming from 14Member States. It of-fers a grasp of what are the main achieve-ments and what kind of experiences are be-ing carried out in some European regionsaround the topic of frailty and functionaldecline. The numerous and varied examplesof Good Practices, promote the visibility ofa wide range of interventions undertakenin clinical settings, research centres and inthe community, aimed to reduce age-relatedfrailty, disability and su�ering associated toit. (see Good practices booklet publication)

• Specific deliverables and potentially trans-ferable results from either individual com-mitments or common work. (see followingsections and annexes)

10

CHAPTER 4. WHATHAS BEENACHIEVED? 11

Deliverable type CountArticles/publications 4IT tools 3Academic courses 1Trainings 2Screening tools 2Functional foods 1Guidelines/protocols 3

Table 4.1: Mapping of deliverables of the Action Group.

4.2 Specific deliverables

Partners have produced speci�c deliveries achiev-ing both common and individual goals in linewiththe Frailty group Action Plan. This report showsonly the individual or common work deliverables�nished by the end of 2014 and points out theones expected by �rst quarter of 2015. Detailedinformation is shown in Annex.

Through a process of informed deliberationcases have been selected that might be clear ex-amples in which policy intervention could reducefrailty and cognitive decline. These cases shouldbe seen as illustrative examples rather than consti-tuting a comprehensive overview of all the actualindividual or common work being developed, andall the thinking behind the di�erent projects andinterventions. They are described in the follow-ing paragraphs as individual and common workdeliverables.

Individual commitmentsBy ’individual deliverables’ we mean the concreteoutcomes of the 128 Individual Commitment sub-mitted through the �rst (41) and the second (87)Calls for Commitments.

At the end of 2013 a mapping exercise aimedto highlight what were the deliverables that frailtygroup partners had plan to achieve in 2014 wasconducted. This database has been shared and dis-cussed with partner. The �nal list of 64 ongoingindividual deliverables for 2014 has been followedup by the European Commission and the involvedstakeholders from September until the end of Oc-

tober 2014. The results of this process are detailedin the annexes.

Each deliverable brings an original input to-wards the achievement of the 3 EIP AHA maingoals. The individual partners’ contributions havebeen grouped under seven broad categories:

• Scienti�c publications

• IT tools

• Academic course

• Training

• Screening tools

• Functional foods

• Consensus documents

These commitments provide examples of in-terventions of how new approaches of prevention,health promotion and care for older people are im-plemented in daily life in di�erent settings and fordi�erent target populations.

Several commitments have delivered results onthe promotion of healthy lifestyles, with interven-tions on physical activity and nutrition that arerelevant to promote healthy and active ageing andprevent frailty.

Health communication is becomingmore andmore important for all kinds of healthcare profes-sionals and care-givers and there is also a need forincreased sharing of knowledge. In this regard anumber of individual commitments are focusedon knowledge gathering and dissemination of re-sults and some others have resulted in scienti�cpublications.


Core achievements of thegroup so far

• Shaping a new model forscreening, treatment andmonitoring of frailty anddunctional decline incommunity and clinicalsettings.

• Scaling up of screeningactivities

• International and interregionalcollaboration (e.g. ondeliverables)

• A more comprehensive andclear understanding of frailtyand its EU policy priorities.

Anumber of partners have delivered results onprevention tools on frailty, malnutrition, and anassessment instrument to predict survival, health-related outcomes and to forecast health resourceuse and costs after discharging frail patients fromhospital.

One partner has developed a new functionalfood rich in bioactive compounds with plant andalgae ingredients. The food is currently under pro-duction at lab scale.

Detailed information on all individual com-mitments delivered until date can be consulted inthe annexes.

Common work and deliverablesCommonworkhas been engaged in since July 2013.The purposes of starting this strand of work areshow below:

• Develop a group with a common approachto speci�c issues e.g. how to promote screen-ing in clinical settings or how to interveneto prevent malnutrition.

• Work on a proactive approach instead ofreactive way.

• Putting together a commonway of thinkingon speci�c frailty related topics.

• Map experiences where knowledge has beenput into practice.

• Map existing useful interventions that aremaking a di�erence at local level (althoughtime is needed to assess results of real changes).

• Identify what has to be done or has to bedone di�erently in speci�c topics.

• Achieve additional results with respect tothose set individually in their respective com-mitments.

• Clarify “state of art” on best interventionson frailty related topics.

Although it is an ongoing activity, a great dealof progress has been made in areas of commoninterest and yields potentially transferable resultsto other settings and target populations.

The common work deliverables re�ect the cur-rent challenges on frailty prevention and treatmentand are evidence based; there are enough articlespublished in scienti�c journals to support the state-ments in which the sub-groups based their activi-ties and recommendations. The deliverables trans-late partners’ knowledge and experience on causesand mechanisms of the ageing process into strate-gies and comprehensive guidelines to prevent andtreat frailty in older people. Furthermore, they aresuitable ways of bringing evidence and providingkey answers on tackling frailty to the attention ofpolicymakers, clinicians and health and social caremanagers.

Key messages resulting from the frailty groupdiscussions, deliverables andpublications are shownin Box 2.


Box 2: Key messages from EIP AHA group on frailty prevention

• Frailty is a complex syndrome of increased vulnerability, determined by lifecourse events, social and psychological environment, which requires timelyinterventions. Because frailty is not an inevitable consequence of ageing, weneed a stronger focus on early diagnosis and screening.

• Frailty, functional, and cognitive decline are highly prevalent in old age andconstitute major public health problems. Understanding frailty is a particularchallenge from a clinical, research and public health perspective. There is aneed to improve the understanding around frailty for healthcare professionals,care personnel, informal and family care-givers and patients.

• An emphasis on prevention can reduce the incidence of frailty and postpone itsonset. People who are fit when they become old and who remain physically andmentally active have a better chance of avoiding or postponing frailty, and areoften also better at managing functional decline when it occurs.

• Older people aged 65 can expect less than half of their remaining years to befree from conditions affecting their ability to manage daily living activities andrequiring both medical and social care on a continuing basis. The risk ofneeding long-term care (LTC) rises steeply from the age of 80. Our ability tomanage it will have major implications for the wellbeing of individuals andfamilies and for public expenditure.

• There is a need to start focusing our attention on function. Efforts should bemade to help people live independently. To achieve this, we need increased useof innovative, coordinated and comprehensive community based prevention,delivered within an integrated health and care system. Furthermore, there is aneed to distinguish between chronic diseases and frailty despite their commongrounds which usually ends in treating them as a unique problem.

• The impact of frailty in health and social services made it clear the importanceand the urgency of tackling and modernising our health and social services.There is a need to shift from reactive disease management to screening,anticipatory care and prevention of frailty and functional decline in old people.Well-planned, coordinated and effective health and social service interventionsin the frail older population can have a significant impact on health outcomes;on quality of life; and on the sustainability of resources.

• There is need not only to prevent frailty, functional decline, malnutrition,cognitive decline and other issues by strengthening prevention and screeningpolicies, but also to find alternative solutions to the institutionalisation ofpatients. These alternatives should include care-givers support, housingadaptations, tele-healthcare networks, professionals training. They willstrengthen the independency of frail people and may act as a brake on thefunctional and cognitive decline of older people.

• Frail older adults require a proactive, multimodal, coordinatedmulti-disciplinary and multiagency approach, preferably delivered in anintegrated health and care system.

5Conclusions and the way forward

The need to tackle frailty in the older people acrossthe EU is now accepted by a large number of stake-holders spanning policy makers, professionals, re-searchers and academics across EUMember States.It can be assume that the focus will be to concen-trate in supporting scaling-up good practices andon the process of developing an EU frailty policy.

The Frailty group partners are committed towork towards solutions that can be easily imple-mented and replicated by others in Europe. Thisaspect emphasises the spirit of the Partnership in abroader context and strengthens the work alreadydone bymany of them. These 3 years of work haveestablished a solid ground on which to build com-mon and e�ective approaches to tackle frailty inolder age. But still further work, policy supportand resources are needed so that tackling frailty inolder people is no longer an issue of public debate.

The work of the Frailty group provides thenecessary input regarding examples of innovativepractices that can improve the quality of life of frailolder people and help reduce the burden of inef-�ciency in care delivery. The on-going work pro-vides a practical illustration of the main elementsupon which to base a future policy on frailty.

Finding new tools and strategies to preventand treat frailty in all its dimensions will not onlyimprove the quality of life of older people dramat-ically, but will also reduce both the number andthe length of hospitalisation and institutionalisa-tion. The �nal results potentially will alleviate thebudgetary pressure of our health and social caresystems, allowing EUMembers States to allocatemore e�ciently the resources for the health andcare of their citizens.

EUMember States need to move from a pri-

marily reactive to an increasingly proactive policyapproach, which seeks both to reduce care demandand toboost cost-e�ective care provision. Such a re-sponse has to be led byMember States’ authorities.The Partnership provides a platform for nationaland regional authorities and key stakeholders tocoordinate and mobilise actions in strategic areas,identify good and relevant practices, �nally repli-cate and scale-up the most needed and successfulsolutions.

In the coming years e�orts aimed at raising ef-fectiveness of care delivery will be crucial. Workingclosely and sharing ideas and solutions can help theEU as a whole to �nd and implement new strate-gies to tackle frailty. This report shows the workprocess and some experiences of the Frailty groupthat could support an EU policy. Through imple-mentation of innovative solutions and new waysof thinking and doing, the Partnership can sup-port to make the needed changes happen fasterand wider.

There is a case for tackling frailty in older peo-ple at EU level: the causes and high prevalence; thenumerous and costly consequences and the rela-tively in-expensive interventions are common to allMember States. Furthermore, this common chal-lenge and its solutions fall across multiple policyspheres; that is why a concerted action is needed, aswell as coordination amongst di�erent stakehold-ers, intervening in 3main areas: screening/assessment;management and research. The work of the Frailtygroup of the EIP on AHA can play a role in sup-porting the building process of an EU policy onfrailty prevention that will support these changes.

14

6Appendix of deliverables andannexes

The appendix contains speci�c information on the collaborative deliverables produced by subgroups.These include:

• Physical Activity Subgroup: Deliverables produced by common work

• Nutrition Subgroup: Deliverables produced by common work

• Frailty & Physical Decline Subgroup: Deliverables produced by common work

• Cognitive Decline Subgroup: Deliverables produced by common work

• Dependency and Caregivers Subgroup: Deliverables produced by common work

It also contains two relevant annexes:

1. The Action Group Partners

2. Individual Commitment Deliverables 2014

15

Physical Activity Subgroup:Deliverables produced bycommon work

Product

White paper on physical activity and its relation with frailty in older people.

Description

Document aiming to disseminate up to date information to clinicians, researchers andmanagers lookingto �nd their way into physical activity and frailty.It looks at: A) what we mean by physical activity, B) how it is operationalized or measured, C) mostrelevant current research issues and D) builds on a structured overview of developing interventions inEurope, under the umbrella of the EIP AHA.

Added value

Increased standardisation of physical activity screening methods, and re�nement of research ques-tions such as: A) the di�erence between measurement of frailty through physical activity and themeasurement of physical function, B)What measuring frailty through physical activity is and what it isnot.

What follows

Publishing the white paper and distribution on the EIP AHA Summit in 1Q of 2015 as an outcome ofthe collaborative work of frailty Action Group.

Comments

The sub-group is working (ongoing activity) also on two other products:1. A research paper on screening of frailty through physical activity. They have has collected structuredinformation on 25 regional commitments related with the measurement of frailty through physicalactivity. This has been done through a custom designed Table of contents distributed via Yammerand email. Preliminary results show that commitments use di�erent batteries of indicators to measurefrailty and pre-frailty status. A pool of over 2000 frail patients from which indicators on physical

16

CHAPTER 6. APPENDIXOFDELIVERABLES ANDANNEXES 17

activity that have been or are being collected all around Europe has been identi�ed and analysed. Ameta-analysis of the results of 25 European studies on screening, monitoring or implementing physicalactivity interventions will contribute to achieve a higher statistical power for the measurements andoutcomes of interest. The paper will be designed during the �rst half of 2015 but key informationwill be collected during the second half of 2015 when most of the interventions under the umbrella ofPhysical Activity Action Area will already have been �nished and published. They have produced abaseline report on strategies for screening, monitoring and managing frailty through physical activityin Europe.2. A European Database onManagement of Frailty, comprising information on screening, monitoringand intervening on frail patients. Well de�ned but poorly standardized frailty indicators and patientselection criteria for interventions have been identi�ed by the group as important barriers for thegeneralization and understanding of the management of frailty in Europe. A population (strati�cation)or individual (targeted screening) approach for the management of frail patients remains nowadays atopic of discussion between healthcare professionals interested in the management of frailty as it refersto a condition for which consensus between experts still needs to be achieved. A European Database onthe management of frailty would serve as a reference for European healthcare professionals that aim to�nd their way through the myriads of documents published on the topic. More likely to be based onthe European reality rather than the easier available North-American literature, the proposed Europeandatabase would help answer current research questions such as: A) 150 minutes of physical activity foreveryone is the standard in the US but can we relate this number for the European reality? B) Are ourfrail populations equal? C) Do we have access to the same facilities? D) Do we share equal bene�ts?The database would build on the results of the EIP AHA Frailty Action Group, not exclusively thephysical activity sub-group. It would be a web based access database starting by collecting informationon a literature search (agreed by all coordinators of Frailty AG on the 22 of October 2014).

Nutrition Subgroup: Deliverablesproduced by common work

Product

1. Consensus Document “Testing and implementing an integrated approach to nutrition: fromassessment to personalized interventions”.2. Organization of an international EIP-AHANutrition workshop in Rome, 17th October 2014.

Description

1. The document presents a common understanding of malnutrition looking at both elderly peoplewho have undernutrition and those with obesity, including those with sarcopenic obesity. It supportsa common vision where e�ective intervention should take into account the entirety of needs thatin�uence the adequacy of nutrition and has a strong focus on primary prevention.2. The workshop was the opportunity to present the consensus document and discuss on di�erentprojects and interventions that individual partners are developing, either as oral sessions or as posterpresentations. It was organized under the auspices of the Mattone Internationale project.

Added value

The group has worked out a consensus document on nutrition with a common vision that brings up anovel integrated nutritional approach with a strong focus on primary prevention. The new aspect offood support will provide new evidence for primary prevention of malnutrition and also create an EUwide change for agriculture, food supply, new jobs and will o�er new economic perspectives.The aim is to improve the chain of care by translating the group knowledge on mechanisms of theageing process, food and culinary innovations, and dietary recommendations into comprehensiveguidelines and strategies to prevent and treat malnutrition in older people.

What follows

The document will be published in the Journal of Aging Research in response to the open call on“Active and Healthy Ageing and Independent Living” by the end 2014.

18


Comments

Partners have also been working on two additional areas which will be further developed in followingyears:1. Nutrition dissemination events e.g: Optimal Nutritional Care for All Implementation ENHAConference, Brussels 2014 or the Health campus events in di�erent regions in Italy.2. Functional Foods and supplements Innovative products development; e.g: Vit. D forti�ed extravirginolive oil (Mataluni); Flavonoid fraction of Bergamot juice; polyphenolic compounds extracted fromgreen lettuce (Lactuca sativa L.; var. Maravilla de Verano).

Frailty & Physical DeclineSubgroup: Deliverables producedby common work

Product

1. Guidelines on instruments for screening and diagnosis of frailty and functional decline.2. Pathways for the management of older people based on their functional status and setting of care

Description

1. The Guidelines analyses frailty and functional impairment assessment tools considering if thesetools have been validated and in which settings they have been used. Furthermore, frailty is a dynamicfunctional state and as frailty, functional decline and disability are di�erent, although they can bepresent at the same time in an older adult, it is necessary to use di�erent tools to assess them. They aredescribed separately in the document2. The pathways document A) gives indications on simple, feasible and brief care approaches andpathways and B) Provides a repository of quality indicators that can be used in di�erent settings inrelation to frailty and physical decline.

Added value

Provides an easy-to-use instrument for decision taking to health professionals that need to assess frailtyin daily practice in clinical and social settings.Provides a framework for the development of integrated care systems for older people and guidelineson levels and ways of care and support that should be provided for each older person according to theirfunctional status and setting of care.Provides a common vision on what an e�ective intervention should take into account.

What follows

Advocacy for using the available instruments in a uniform way so that the likelihood of having homo-geneous and interchangeable data from all the EU regions will increase signi�cantly.Advocacy for implementing this approach in clinical and social care settings.

20


Comments

The work of this sub-group adds to the growing interest on the topic of healthy ageing. It has beenpresented in a symposium in theWorld Congress on Gynaecological Oncology (Florence 2014) andwill be in the coming European Congress of EMAS inMadrid (2015).The sub-group is also working (ongoing activity) on three other products that will be ready for Q12015:1. The use of a serious games platform in screening for mild cognitive decline. Validation of the tooland large scale screening on people older than 50 years living in the community. It links 3D virtualtasks to the assessment of cognitive function, giving close consideration to usability and validation.2. Revision of biomarkers to follow-up cognitive decline and dementia. Based on a critical approach tothe role of biomarkers from biological �uids and magnetic resonance images in the management ofcognitive decline.3. Status of art concerning monitoring of the main forms of cognitive decline. They have prepared anarticle “Functional and structural magnetic resonance for detection of neurological impairment”.4. Analyses of datasets fromongoing longitudinal studies in the trajectories of cognitive decline betweenfour longitudinal studies in England [English Longitudinal Study of Ageing (ELSA)], Ireland [IrishLongitudinal Study on Ageing (TILDA)], Spain [Chronic Ailment Reduction after Menopause(CARMEN)] and the smaller scale Extra Care data in England. It will facilitate sharing of analyses andmodelling delivering insights into the predictors of transitions. It will give anthropometric data ofwomen from 4 di�erent European countries.

Cognitive Decline Subgroup:Deliverables produced bycommon work

Product

Scienti�c publication

Description

It is the �rst result of a common task developed by this sub-group. A review of evolution of MCI(mild cognitive impairment) to dementia will be published in complete issue of the scienti�c journalMaturitas (1st quartile in the JSR), which will be entitled: “Personalized healthcare for midlife andbeyond” is being prepared, the editors being Prof. AntonioCano and Prof. Tommasso Simoncini, fromthe University of Pisa, Italy. The contents will include 15 papers, whose authors, already con�rmed andlisted, are �rst-rank scientists from all over the globe. Together with the inclusion in EIP AHA of theeditor, the common work of the group is represented by the participation of Prof. L Calzá as author ofthe paper number 13 (Should we screen. . . ?, see below). The publication is due for the 1Q 2015.

Added value

The impact on the scienti�c community with interest on ageing: Maturitas is a high impact journalread around the world, but more particularly in Europe and North America. The scope of the journalis all aspects related with ageing.

What follows

The publication will increase the interest on aspects related with EIPAHA, and has involved theparticipation of EMAS (European Society of Menopause and Andropause) in one application to oneof the recent Horizon Calls (PHC26), where several members of the cognitive decline group wereparticipating

Comments

The work of this sub-group adds to the growing interest on the topic of healthy ageing. It has beenpresented in a symposium in theWorld Congress on Gynaecological Oncology (Florence 2014) and

22


will be in the coming European Congress of EMAS inMadrid (2015).The sub-group is also working (ongoing activity) on three other products that will be ready for Q12015:1. The use of a serious games platform in screening for mild cognitive decline. Validation of the tooland large scale screening on people older than 50 years living in the community. It links 3D virtualtasks to the assessment of cognitive function, giving close consideration to usability and validation.2. Revision of biomarkers to follow-up cognitive decline and dementia. Based on a critical approach tothe role of biomarkers from biological �uids and magnetic resonance images in the management ofcognitive decline.3. Status of art concerning monitoring of the main forms of cognitive decline. They have prepared anarticle “Functional and structural magnetic resonance for detection of neurological impairment”.4. Analyses of datasets fromongoing longitudinal studies in the trajectories of cognitive decline betweenfour longitudinal studies in England [English Longitudinal Study of Ageing (ELSA)], Ireland [IrishLongitudinal Study on Ageing (TILDA)], Spain [Chronic Ailment Reduction after Menopause(CARMEN)] and the smaller scale Extra Care data in England. It will facilitate sharing of analyses andmodelling delivering insights into the predictors of transitions. It will give anthropometric data ofwomen from 4 di�erent European countries.

Dependency and CaregiversSubgroup: Deliverables producedby common work

Product

CARTS programme ( Community Assessment of Risk and Treatment Strategies)Short screening tool (RISC) and Community Assessment of Risk Tool (CART) tools

Description

Screening for Frailty as a state of vulnerability that causes risks of institutionalisation, hospitalisationand death. Short screening tool (RISC), this short screening tool scores concerns in three domains,mental state, ADL and medical issues.It also scores concerns, their severity and caregiver capacity to manage these concerns. Finally, it scoresglobal risk of three adverse outcomes nursing home placement, hospitalization and death. It uses asimple score sheet, developed in Ireland as part of the CARTS programme, within the framework ofthe 3 star reference site COLLAGE. . . . and tested in Portugal, Spain, Northern Ireland and Australia.In Ireland, 803 people were screened in 2012 and followed. The one-year incidence of institutionali-sation, hospitalisation and death was determined and the accuracy of the RISC was compared to theClinical Frailty Scale (CFS).This study looks at high-risk individuals only, so fundamentally looks at a di�erent group of peoplethan the CFS. High-risk individuals in this methodology, interestingly, have a higher risk of adverseoutcomes, and the model of frailty here, looking at these outcomes of interest, is better than the CFS.The fundamental point is that a major contribution to risk is the caregiver network, rather than theperson themselves. The ability of the caregiver network to manage issues is a bigger predictor of theseadverse outcomes than the problems themselves.Screening in other countries using theRISC tool: Ireland 803/Portugal 1318/ Spain, Barcelona 374/Aus-tralia 468/Northern Ireland 294.

Added value

This innovative approach will screen large numbers of individuals quickly to provide a pro�le of riskin the community and identify associated causes. A central outcome of this work will be to provide arisk pro�le of this community, document the natural history of risk with various outcomes e.g. frailty,hospitalization, nursing home placement and death. At the same time, it will identify the healthcareneeds of this vulnerable population, to build capacity and inform service planning to make healthcare

24


systems more e�cient, safe and sustainable.The programme is standardized, with rigorous administration and scoring guidelines and trainingprograms that are standardized and validated. It has shown versatility across other EU regions and caneasily be customised and up-scaled.

What follows

An application for Horizon 2020 has been submitted to Implement and evaluate the CommunityAssessment of Risk and Treatment Strategies (CARTS) programme. This project will study the e�ectsof an innovative multifactorial screening, triage with targeted interventions on adverse outcomes(hospitalisation, institutionalisation and death) in community dwelling older adults. The primaryobjective of the I.E.CARTS research programme is to evaluate and compare new detailed screeningand assessment tools together with treatment strategies, to guide primary healthcare professionals toidentify community dwelling older adults (>70 years) at high risk of adverse outcomes and to testinterventions that may decrease the risk of adverse outcomes in nine countries (Ireland, UK, Spain,Portugal, Germany, the Netherlands, Australia, Canada and Turkey).We are continuing to screen and follow older adults in the community, in the UK, Australia, Portugaland Spain. In Ireland, high risk people have been identi�ed and a comprehensive targeted geriatricassessment is being piloted in a subsample.There are two students currently doing PhD’s on the CARTS in University of Oporto, supervised byProfessor Costanca Paul.An application for a 3 year Health Research Board fellowship award has been submitted to fund amedical PhD student to develop the interventions care pathways for those identi�ed as high risk ofadverse outcomes.

Comments

Provides an example of collaborativeworkwithin the EIPAHA.Based on anewparadigmand approachto frailty screening and management. In this research “frailty” has been operationalized as “risk ofadverse events” (hospitalization, death and nursing home placement)The RISC tool has been translated into Portuguese and Spanish. Training in Porto, Ireland, Australia,Northern Ireland, and Barcelona. This included nurses, physicians, GPs, psychologists and allied healthprofessionals. A “train the trainer”model was applied where up to 50 people received the initial trainingprogramme and education tools through face-to-face workshops.This included didactic lectures on risk with practical sessions using training cases. The duration oftraining was 2 days.Focus groups and problems using the tool were identi�ed. Focus groups have been conducted withhealthcare professionals who have used the screening tool, in practice. Professionals interviewed werepublic health nurses, social workers, consultants, GPs. Five countries were involved; Ireland (n=5),UK (n=8), Portugal (n=4), Australia (n=4) and Spain (n=7). A publication on this experience hasbeen drafted and is due for submission to Age and aging (Multidisciplinary Health Care Professionals’experiences of using the Risk Instrument for Screening in the Community (RISC): A cross culturalperspective).Three papers have been published/accepted on the data collected to date:1. Rónán O’Caoimh, Yang Gao, Anton Svendrovski, Elizabeth Healy, Elizabeth O’Connell, GabrielleO’Kee�e, Eileen O’Herlihy, Una Cronin, Nicola Cornally, and William D. Molloy. "Screening formarkers of frailty and perceived risk of adverse outcomes using the Risk Instrument for Screening in


the Community (RISC)." BMC geriatrics 14, no. 1 (2014): 104. http://www.biomedcentral.com/1471-2318/14/1042. The Community Assessment of Risk Instrument: Investigation of Inter-rater Reliability of anInstrument Measuring Risk of Adverse Outcomes. Journal of Frailty and Aging, 2014, epub ahead ofpress, see http://www.jfrailtyaging.com/current-issue.html3. Leahy-Warren P, O’Caoimh R, Fitzgerald C, Cochrane A, Svendrovski A, Cronin U, O’Herlihy E,Cornally N, FitzGerald C, Gao Y, Healy E, O’Connell E, O’Kee�e G, Coveney S, McGlynn J, ClarnetteR, Molloy DW. Components of the Risk Instrument for Screening in the Community (RISC) thatpredict Public Health Nurses’ perception of risk. Journal of Frailty and Aging 2014, in press.

Annex 1: The Action GroupPartners

After the two rounds of call for commitments launched by the European Commission, 160 partnersexpressing a total of 131 commitments, started working together in this multidisciplinary ActionGroup (AG). It brings together public health authorities, care organisations, academia, research centres,industries, patients associations and professional bodies from across most European countries. Sectoralcomposition can be seen in the main text in Figure 2.1. Country composition can be seen in Figure 6.1below.

Figure 6.1: Country composition of the Action Group on Frailty

!

A list of partners and their commitments follows below:

Organisation Commitment name Group Country

MelabevMISTRAL - EuropeanCommunities for Active andHealthy Aging

Miscellaneous Portugal

Medical University of Graz Medical University of Graz Nutrition Austria

27



AESGP - Association of theEuropean Self-MedicationIndustry

Improving nutrition in theelderly Nutrition Belgium

Armonea Gastrological approach tomalnutrition Nutrition Belgium

Center for Gastrology Gastrological approach onmalnutrition Nutrition Belgium

CPME - Standing Committeeof European Doctors

Health literacy of frailty &functional decline.I2FRESCO. Coordinators onpatient empowerment

Frailty in general Belgium

EFPA - European Federationof Psychologists’ Associations.Advocacy organisation.

Guidelines for PsychologistsPractice and for Older AdultsPromoting Active andHealthy Ageing


European Region of theWorld Confederation forPhysical Therapy

Active and Healthy - The roleof the physical therapist inphysical activity

Physical activity Belgium

European Union GeriatricMedicine Society/ EuropeanNutrition Health Alliance

Frailty AG Screening Group/systematic screening Frailty in general Belgium

Heales Knowing E�ects on HealthyLife Years


HUB-KAHO (UniversityCollege Brussels-Gent)

Gastrological approach tomalnutrition Nutrition Belgium

interRAI

Continuity of care andprevention of functionaldecline and frailty with theinterRAI instruments

Functional decline Belgium

KHLeuven University

FRAGIL (Action forprevention of functionaldecline and frailty) / Physicaland self-perceived fatigue asindicators of functionaldecline and frailty in olderadults

Functional decline Belgium

MINI/Danone / Nutricia Screening for NutritionalStatus Nutrition Belgium

Orange House PartnershipFood and Nutrition AssistedHealthy Ageing by developingpersonalised detailedinformation


University of Luxembourg

Guidelines for PsychologistsPractice and for Older AdultsPromoting Active andHealthy Ageing

NA Belgium



Vrije Universiteit Brussel robots that care Functional decline Belgium

Danish TechnologicalInstitute / TeknologiskInstitut

FATOM (Fat in Osseous andMuscle Tissues) Functional decline Denmark

International Sport andCulture Association ACTIVEAGE Physical activity Denmark

P�zer Consumer Healthcare Nutrition/ functional decline Nutrition Denmark

University of Eastern Finland Age Innovation Project2012–2014

Care givers & Dependency Finland

INSA LYON, Lab ICBMSINSA Lyon CNRS Univ Lyon1 CPE

Chemical biology approach tonew foods, delivery strategiesand therapeutics related toageing

Nutrition France

Sano�

Integrated Interventionagainst physical Frailty: aEuropean Study in theCOmmunity - i2-fresco

Functional decline France

Sceaux Longévité Santé Knowing E�ects on HealthyLife Years

Frailty in general France

University/INSERM Laurence Vico Physical activity France

Christian-Albrechts-UniversityKiel

De�nition of sarcopenia andsarcopenic obesity based onmagnetic resonance imaging

Nutrition Germany

Eurice GmbH LipiDiDiet Nutrition Germany

IGV Institut fürGetreideverarbeitung GmbH

Frailty and functional decline(INNOVACTIVESConsortium

Frailty in general Germany

Rostock University - Institutefor biostatistics andinformatics in medicine andageing research

Quanti�edHealth(Quanti�ed Self IntelligentFor More Healthy Life Years)

Frailty in general Germany

Saarland University, theLipiDiDiet Consortium LipiDiDiet Nutrition Germany

Aristotle University ofThessaloniki

Long Lasting Memories Cognitive decline Greece



Trinity College DublinEngAGE Centre for Researchon Ageing

SOCIAL, TILDA, NILVAD,IN-BIND Social connectionin older people at risk ofloneliness (SOCIAL)The Irish Longitudinal Studyon Ageing (TILDA) - Avalidated measure forscreening of frailty.A European multicentredouble-blindplacebo-controlled phase IIItrial of nilvadipine in mild tomoderate Alzheimer’s disease(NILVAD) EngAGE

Cognitive decline Ireland

Trinity College Dublin, NEIL,NeuroEnhancement forIndependent Lives, Instituteof Neuroscience

A Sharing Approach toPromoting Science - ASAPS Cognitive decline Ireland

University College Cork

CARTS - CommunityAssessment of Risk andTreatment Strategies / RapidCognitive CommunityScreening Program

Caregivers Ireland

ACLI Sport Union GOAL Physical Activity Italy

Agenzia Sanitaria e SocialeRegionale (ASSR) - RegioneEmilia Romagna

Cognitive component in thefrailty syndrome Cognitive decline Italy

ASL Salerno GOALNutrition / CulinaryApproach Italy

Azienda Sanitaria LocaleCaserta, area TD

GOAL - Getting OptimiseAgeing Life-quality Miscellaneous Italy

Catholic University of Rome -Department of Gerontologyand Geriatrics

Frailty Functional decline Italy

Consorzio di Bioingegneria eInformatica Medica - CBIM

Smart Ageing Cognitive decline Italy

Fondazione ANT Italia OnlusFrialty - WP2 Targetpopulation and programs Frailty in general Italy

Fondazione GiovanniLorenzini Medical ScienceFoundation

Prevention and managementof age-related loss of capacities Cognitive decline Italy



Fondazione Irccs Ca’ GrandaOspedale Maggiore Policlinico(short name IRCCS CA’GRANDA)

1. Physical training and/ orrehabilitation in the frailelderly in hospital and athome (PHYTRAIL) 2.(Action-Group Frailty:Action For Prevention OfFunctional Decline AndFrailty)

Physical activity Italy

Gens, Federico II University GOAL Care givers Italy

Institute of Food Science ofthe National ResearchCouncil, ISA-CNR

NEWAGE / Strategies for thedevelopment of new healthyfoods for the management offrailty and ageing

Nutrition Italy

ISBEM – Istituto Scienti�coBiomedico EuroMediterraneo

EuroMediterranean registryof osteoporosis Miscellaneous Italy

Istituto Superiore MarioBoella, Torino (Italy);International University ofJapan, Niigata (Japan)

MFI - Successful Aging Frailty in general Italy

Monaldi Hospital in Naples GOAL Physical activity Italy

Regione del Veneto, ItalyTheMarco Polo Initiative:Using a MultidimensionalPrognostic Index (MPI)

Miscellaneous(www.mpiage.eu) Italy

SI4LIFE scrl

FRAGILE - Frailty Researchand Assessment-interventionin liGurian InterdisciplinaryLaboratory for the Elderl

Functional Decline Italy

SI4LIFE SCRL Scienza eImpresa per migliorare laqualità della vita

Regione Liguria Reference siteEIP-AHA

Frailty in general Italy

University of BolognaFrailty: Action for preventionof functional decline andfrailty

Nutrition Italy

University of Bologna -Regional Agency for Healthand Social Care of EmiliaRomagna

Functional Decline Nutrition Italy

University of Florence -Department of Surgery andTranslational Medicine,Section of Endocrinology andMetabolism

Optimizing nutrition andphysical activity in healthyageing: intervention onsubclinical frailty

Functional decline Italy

University of Milano-BicoccaEIP on AHA Frailty AGPrevention of Frailty andfunctional decline




University of Milano-BicoccaHealthy ageing withinnovative functionalfoods/leads for degenerativeand metabolic diseases


University of Molise -Department of Agriculture,Environment, Food (DiAAA)

Functional foods andmicrobial components able toimprove the wellbeing inolder people (FFoAM-WeOP)/ New age foods

Nutrition Italy

University of Naples FedericoII

An integrated model of care,cure and prevention forfraility osteoporosis and itscomplications


University of Naples FedericoII GOAL Functional Decline Italy

University of Naples FedericoII GOAL Cognitive decline Italy

University of Naples FedericoII

Healty ageing with innovativefunctional foods/leads fordegenerative metabolicdiseases


University of Naples FedericoII MOLAGE Frailty in General / Research Italy

University of Padova andVeneto Region

HARDEnDEEP - HealthyAgeing in Residential andDomestic Environment byDeveloping Exercise Eventsand Programs


University of Salerno,Department of Medicine

Biomedical EnterprisesLeading Over Various ElderlyDiseases - Beloved

Frailty in general Italy

University of Salerno,Department of Medicine

Newmolecular determinantsand pathogenic mechanismsin age-related diseases -MOLAGE

Frailty in general / Research Italy

University of Torino,Department of Psychology

MultiFactorial Interventionfor a Successful Aging Frailty in general Italy

University of Torino, SurgicalSciences

Dysphagia health and carepathway for elderly patients Nutrition Italy

University of Verona - Facultyof Exercise and Sport Science

Active lifestyle in citysupporting older peopleexercises


University of Verona - Facultyof Exercise and Sport Science

PhD - Early CompleteDiagnosis and Protocol ofPersonalized Exercises forOlder People




SIPI- Italian Society ofPsychology of Ageing /Società Italiana di Psicologiadell’Invecchiamento

Active Longer Life (ALL) forSpeci�c Action Frailty AG:Action for prevention offunctional decline and frailty /

Frailty in general Italy/ Switzerland

Coöperatie Slimmer Leven2020

Framework for Optimizingthe process of FeeDing Nutrition Netherlands

Hanze University of AppliedSciences Groningen (HealthyAgeing Network NorthernNetherlands)

EIP AHA action plan FrailtyAG Functional Decline Netherlands

Hanze University of AppliedSciences Groningen (HealthyAgeing Network NorthernNetherlands)

NutrEx Functional Decline Netherlands

Markiva BV East - West seniors Frailty in general Netherlands

Medical Delta Medical Delta Vitality Functional decline Netherlands

Netherlands Organisation forApplied Scienti�c ResearchTNO

Supervised diagnosis,monitoring and therapy athome for patients withchronic health conditions

Frailty in general Netherlands

Radboud UniversityNijmegenMedical Centre

Dutch Healthy ElderlyRemote Control VitalityLESsons Project

Functional decline Netherlands

University Medical CenterUtrecht

Vascular CognitiveImpairment Program Cognitive decline Netherlands

University Medical CenterUtrecht

Vascular CognitiveImpairment Program -University Medical CenterUtrecht

Frailty in general Netherlands

University of Utrecht - JuliusCenter for Health Sciencesand Primary Care

Older Immigrants and Activeand Healthy Ageing Frailty in general Netherlands

University Twente, UniversityMaastricht, TNO and Nivel) CCTR Physical activity Netherlands

Norrig Wellness Solutions Personalised Healthy DietaryFibre Meal Plan Solutions Nutrition Nigeria

Instytut Fizjologii i PatologiiS_uchu (eng.: Institute ofPhysiology and Pathology ofHearing)

Preventing hearing disabilitiesand their consequences inorder to avoid the loss offunctionality

Cognitive decline Poland

University of Coimbra,Center for Neuroscience andCell Biology (CNBC/UC

Healthy ageing withinnovative functionalfoods/leads for degenerativeand metabolic diseases

Cognitive decline Portugal



Católica Porto

Rede de Cooperação dasIrmandades e Instituições deSolidariedade – qualidade devida

Frailty in general Portugal

Centre of Marine Sciences ofAlgarve (CCMAR)


Nutrition Portugal

Escola Superior de Tecnologiada Saúde de Lisboa

Active life styles andpredictors of risk forincapacity on seniorpopulation

Functional decline Portugal

Faculty of Pharmacy at theUniversity of Lisbon (FFUL)and its research unit iMed.UL

Health Ageing withInnovative FunctionalFoods/Needs for DegenerativeandMetabolic Diseases


Fundação da Faculdade deCiências da Universidade deLisboa


Nutrition Portugal

IBET/ITQBHealthy ageing withinnovative functionalfoods/leads for degenerativeand metabolic diseases

Nutrition Portugal

S. Brás de Alportel MedicalRehabilitation Centre(CMR-Sul)

Integrated Patient RiskAssessment andManagementSystem of the Algarve


School of Health of thePolytechnic Institute ofBragança (Portugal)

Be Home Be Happy –Observatory for the Qualityof Life of the Elderly Living inthe Community

Care givers & Dependency Portugal

UNIFAI - Research andEducation Unit on Ageing,Porto/ ICBAS-UP

Frailty in old people:guidelines for assessment andintervention


UNIFAI - Research andEducation Unit on Ageing,Porto/ ICBAS-UP

UP Ageing Network:NoDecline. "Prevention andearly diagnosis of functionaldecline in older people riskconditions, needs and services,for chronic conditions,dementia and frailty" and"AgeUP-NoDecline - Actingon the prevention offunctional decline and Frailty"

Frailty in general / Caregivers Portugal

Universidade da Beira InteriorFunctional products forage-related diseases Nutrition Portugal



University of Algarve - Schoolof Health

Pharmacological, Exercise andNutritional Approach toOsteoarthritis in Elderly

Physical activity Portugal

University of Aveiro MISTRAL Frailty in general Portugal

University of Coimbra Ageing@Coimbra Cognitive Decline Portugal

University of Evora

Prevention and early diagnosisof frailty and functionaldecline, both physical andcognitive


University of Minho Frailty AG EIP(Caregivers/Dependency) Cognitive decline Portugal

University of MinhoDi�erential cognitive declineand relationship withimmunesenescence pro�le


University of MinhoInCARE - Intervention incaregivers who care for oldpeople after a stroke

Care givers & Dependency Portugal

University of MinhoPromote healthy brain agingby modulation of riskbiomarkers


University of PortoActing on the prevention offunctional decline and frailty /UP Ageing Network:NoDecline


S&Heron d.o.o.

ProBack 4 - Intelligentexercise apparatus andprocedure for rehabilitation ofchronic low back pain - CLBP

Physical activity Slovenia

University of Primorska,Science and Research Centreof Koper, The Institute forKinesiology Research (UPSRC)

Pangea, NEOPANGEA -NewOpportunities inPhysical Activities andNutrition for Quality Ageing

Physical activity Slovenia

Allinky Biopharma Chronic in�ammationhampering healthy ageing Functional Decline Spain

Allinky Biopharma In�ammageing Functional Decline Spain

ANDALUSIAN SCHOOLOF PUBLICHEALTH

Longitudinal study of womenand men caregiver’s healthand quality of life in twoSpanish regions

Care givers & Dependency Spain

AQUAPORINS&INGREDIENTS SL

New Food Productsenhancing the Cognitive andPhysical Performance of theAging Adults

Nutrition Spain



Bioarray, SL

Adhesion to initiative“Controlled exercise as anintervention to prevent frailty,de�nition of pr

Physical activity Spain

Bio-Med AragonFrailty AG: Action forprevention of functionaldecline and frailty

Functional decline Spain

CIBERSAMAssessment of thedeterminants of frailty inEuropean countries (ADFE)

Frailty in general Spain

Consorci InstitutD’Investigacions BiomèdiquesAugust Pi I Sunyer(IDIBAPS)

Functioning in elderly withbipolar disorder (EVALUA) Cognitive decline Spain

Fundació Privada Parc deSalut de Sabadell (short name:Parc de Salut)

Multisectorial contributionon R+D+i for frailtyprevention on elderly people

Nutrition Spain

Fundacion CV Centro deInvestigacion Principe Felipe

1. Biomarkers in blood forcognitive and functionaldecline in patients withchronic liver disease; 2. Newimaging tools for earlydiagnosis of cognitive andfunctional decline 3. ValenciaNetwork on Cognitive andFunctional Decline- Magneticresonance imaging biomarkers

Cognitive decline Spain

Fundación InvestigaciónClínico de Valencia. Institutode Investigación Sanitaria –INCLIVA

Biomarkers of cognitive andfunctional decline frommagnetic resonance imagingin patients with chronic liverdisease


FundaciónMarqués deValdecilla (FMV) - IFIMAV

Preventing mental health -related problems in the elderly- MENTHELDER


IDIAP Jordi GolFrailty AG. Promoting activehealthy ageing from PrimaryHealth Care in Catalonia

Functional decline / Caregivers Spain

IK4 Cidetec

An user-friendly, minimallytime consuming, sensitive &speci�c screening tool whichenables the early diagnosis offunctional decline.


IK4 Research AllianceEuropean Action forPrevention of FunctionalDecline and Frailty




Institute of Biomechanics ofValencia

Frailty prevention and delaythrough functionalassessment of daily activities


Instituto de Bioingenieria,UniversidadMiguelHernandez

Adherence to older peoplesports Physical acitivity Spain

Instituto deNeurociencias-UniversidadMiguel Hernandez de Elche

Alzheimer monitoring forearly diagnosis (Missing) Spain

KRONIKGUNE on behalf ofthe Department of Health ofthe Basque Government

Prediction of frailty andanalysis of epidemiologicburden of neurodegenerativedisorders


Pablo de Olavide University,Sevilla-Spain

Online program to evaluateand train the executivefunction


Parc Sanitari Sant Joan deDéu-Fundació Sant Joan deDéu

Assessment of thedeterminants of frailty ineuropean countries


Pasqual Maragall Maragall

Cognitive Characterization forAssessment of Risk ofFunctional Decline/PasqualMaragall Foundation


PUBLICHEALTHAGENCYOF CATALONIA

Active Health Ageing througha healthy diet and physicalactivity in Catalonia


Sermas Hospital Universitariode Getafe/GlobalManagement of Frailty inClinical Settings

Global management of frailtyin clinical settings -FRAILCLINIC


Spanish Collaborating Centreof the Joanna Briggs Institutein collaboration with Nursingand Health

Healthcare programme,activities and therapeuticinterventions to preventfrailty


Spanish Network of HealthyCities (RECS)-SpanishFederation of Mucipipalitiesand Provinces (FEMP)

Assessment of nutritionalstatus, physical, a�ective,cognitive and socialfunctioning in elderly

Miscellaneous Spain

TECNALIA Research &Innovation

HeAlthy nutrition and ICTfor actiVE ageiNg andprevention of frailty anddementia

Nutrition Spain

THEOLD PEOPLEHEALTHOBSERVATORY.Ayuntamiento de Villanuevade la Cañada

Coordinated Use ofMunicipal health resources byPrimary care team. The «CUMPcare programme »

Miscellaneous Spain



The Spanish NationalResearch Council (CSIC)

Carbohydrates for health,wellness and pleasure:prebiotic caramels -CARAMEL

Nutrition Spain

The Spanish NationalResearch Council (CSIC) Nutreteudo & TELAGDIS Nutrition Spain


Prevention and treatment oftelomere shortening in agingand age-related diseases



Social networks todisseminate nutritional habitsfor elderly to improve theirquality of hearing

Nutrition Spain

UniversidadMiguelHernandez - Research SportCentre

Adherence to older peoplesports Physical activity Spain

University of Alicante

Elaboration of a tool ofdecision making to reducemalnutrition risks in theelderly

Nutrition Spain

University of Madrid (SanPablo CEUUniversity)

Evaluation of NutritionalStatus in the elderly; Impactof food forti�cation andsupplements for a betterhealthy and vitality ageing;Role of nutrition inpreventing the loss of hearingduring the aging process

Nutrition Spain

University of Santiago deCompostela

Research on glyco &peptide-based drug leads:teaching and discoveryapplied to age-related diseases


University of Seville“Healthy ageing withinnovative functionalfoods/leads for degenerativeand metabolic diseases”

Nutrition Spain

University of SevilleCarbohydrates for health,wellness and pleasure:prebiotic caramels


University of ValenciaCognitive compensation,reserve and plasticity inAgeing

Nutrition Spain

University of Valencia E�ects of the Mediterraneandiet on healthy aging. Nutrition Spain



University of ValenciaEpigenomic approaches forageing, frailty, vascularrarefaction and insulinresistance conditions

Nutrition Spain

University of Valencia UVEG participation in EIPAHA coordinator Nutrition Spain

University of Valencia(UVEG)

Chronic diseases preventionby implementation of healthylifestyle habits inpostmenopausal women.CARMEN



Cognitive compensation,reserve and plasticity inAgeing. CoRe-Plas



E�ects of the Mediterraneandiet on healthy aging.HEALTHYMEDIET

Nutrition Spain


Epigenomic approaches forageing, frailty, vascularrarefaction and insulinresistance conditions.EPYFRAILTY



Evaluation of Cognitive andFunctional Impairment for anActive and IndependentAging. EVALUA


University of Valencia(UVEG) Long Lasting Memories Cognitive decline Spain


Prevention of Frailty byCorrect Nutrition andControlled Physical exercise.FRESHAGE



Psychosocial andpsycobiological approach toprevent age functional declineand frailty. AGEWELL


University Santiago deCompostela

Research on glyco &peptide-based drug leads:teaching and discoveryapplied to age-related diseases


Stockholm County CouncilImproving healthcare andsocial care for the elderly inStockholm Region

Frailty in general Sweden

Nestlé Health ScienceAction Group - Age RelatedUndernutrition in Europe Nutrition Switzerland



Academic Medical Center(AMC)

European DementiaPrevention Initiative

Cognitive decline The Netherlands

Aston University - AstonResearch Centre for HealthyAgeing (ARCHA)

ARCHA Nutrition United Kingdom

Aston University - AstonResearch Centre for HealthyAgeing (ARCHA)

Healthy ageing metabolismand nutrients Nutrition United Kingdom

Clinical TranslationalResearch and InnovationCentre

Healthcare Innovation Miscellaneous United Kingdom

Department of Health, SocialServices and Public Safety(Nothern Ireland)

Connecting nutrition researchevidence to older people’smeals

Nutrition / Functional decline United Kingdom

Department of Health, SocialServices and Public Safety(Nothern Ireland)

Continuity of care andprevention of functionaldecline and frailty with theinterRAI instruments

Nutrition / Functional decline United Kingdom

EFAD - European Federationof the Associations ofDietitians/ EuropeanNutrition Health Alliance

Action Group on Age RelatedUndernutrition Nutrition United Kingdom

European Nutrition forHealth Alliance

Action Group on Age RelatedUndernutrition Nutrition United Kingdom

International LongevityCentre

(Missing) Nutrition United Kingdom

NHS Scotland co-ordinatedby NHS 24 An Acute Focus on Frailty Functional decline United Kingdom

The Bone and Joint Decade Musculoskeletal DataResearch Analysis Tool Functional decline United Kingdom

University College London/European Calci�ed TissueSociety

FATOM (Missing) United Kingdom

University of Essex

Multimodal InterventionsSupported by informationand communicationTechnologies buildingResilience for frAiLtyprevention (MISTRAL)

(Missing) United Kingdom

Annex 2: Individual CommitmentDeliverables 2014

Promotion of healthy lifestyles.

1. TheUniversity of Valencia produced a validated protocol to prevent osteoporosis in post-menopausalwomen. It includes a risk strati�cation tool and a follow up programme based on physical exercise withan elastic thera-band.

2. Another running protocol, issued by the Institute of Biomechanics of Valencia, aims to delayfrailty status through the improvement of balance in older people. As in the previous example, theexercised proposed can be performed in private houses as well as in nursing home.

3. Another department of the University of Valencia has published a study result on the capacity toevaluate and analyse retirement predictors a second one on the motivation to keep older people activeat work have been carried out and their �ndings published in a scienti�c journal.

4& 5. Two di�erent training activities have been organisedwith the aim to improve healthy lifestyle.The �rst one, from the U.S.ACLI Italy, concerns the promotion of physical activities among olderpeople; in the �rst six months of 2014 alone, 47 "Walking for Health" events were organised. Thesecond training, organised by the Centre for Gastrology, targeted chefs committed to maintain andimprove well-being and health of old people providing themwith safer and healthier foods. Knowledgegathering and dissemination

Almost 40% of the individual deliverables targeted knowledge gathering and dissemination, al-though they took a variety of approaches.

1. The need of integrate current healthcare professional educations with new topics and subjectshas been highlighted by many A3 partners. In response to this concern, the Faculty of Pharmacy ofthe University of Lisbon organised four new courses of Biopharmaceutical Sciences structured withinmaster and doctoral programs. Twenty students enrolled in the following courses: Development andOrganization of the Nervous System, Brain Barriers in Drug Development, Neuropathology andNeuropharmacology and Pathophysiology of Neuroin�ammation.

2. A data platform to collect risk biomarkers has been set up by the University of Minho alongwith the Life and Health Science Research Institute. The data are elaborated to allow a strati�cation ofthe risk of cognitive decline to promote early detection of the high risk patients. Thanks to this speci�cinformation, tailored and more e�cient prevention approached are identi�ed.

3. The International Sport and Culture Association published a guide on capacity building ofstrategies and programs in sport organisations speci�c for older people (Active Age Handbook).

4. An ad hoc questionnaire to test the relation between engagement into cultural and social activitiesand well-being has been developed and administered by the Federico II University together with theNGOGENS. Preliminary analysis indicates that there is a direct and signi�cant correlation betweenwell-being and cultural and social engagement in over 60 years old subjects.

41


5. The Agencia Estatal Consejo Superior de Investigaciones Cientí�cas opened a Twitter accountto increased awareness on the importance of hearing impairment for active ageing, and on the impactof nutrition on hearing loss has been created. The ultimate goal of the project is to improve diet habitsin order to prevent/delay the onset of age-related hearing loss, while having an impact on the risk offalling.

Scientific publications

Two partners published in scienti�c international journals their research results. The Aston Universityon the prevention of progression from pre-frailty to frailty status in older people through the study ofthe nutrient status with particular focus on fatty acids and antioxidant nutrients. The Veneto regionpublished the results of aMultidimensional Prognostic Index -MPI testing phase carried out in geriatricwards. In an e�ort to boost the added value of telemedicine for physical rehabilitation the RoessinghResearch and Development produced a scienti�c dissertation now publicly available.

Better prevention tools

1. The Research and Education Unit on Ageing of UNIFAI conducted a literature review for thepurpose of adapting existing instruments to measure frailty and estimating the prevalence of frailty inthe population in Portugal. As a result using the phenotypes of frailty (Fried et al, 2001) as a goldenpattern the following two instruments have been adapted:

i. Groningen Frailty Indicator (GFI) (Schuurmans, H., Steverink, N., Lindenberg, S., Frieswijk, N.,& Slates, J., 2004).

ii. Tilburg Frailty Indicator (TFI) (Gobbens, van Assen, Luijkx, Wijnen-Sponselee, & Schols,2010).

2. Hanze University of Applied Science Groningen develop an app as a means to conduct a quickand easy assessment of malnutrition and frailty (risk). The tool aims to enhance patient empowerment,promotion of independent living, early detection of (pre-) frailty or malnutrition (risk) and promptingtimely interventions.

3. VenetoRegion employed a prognostic index (MPI) as aMultidimensional assessment instrumentto discharging frail patients from Geriatric wards to predict survival, health-related outcomes and toforecast health resource use and costs. The results drive the choice of health interventions for frailindividuals that present the best cost-e�ectiveness pro�le.

New functional foods

Finally, Aquaporins & Ingredients SL developed a new functional food rich in bioactive compoundswith plant and algae ingredients. The food is currently under production at lab scale.

List of 2014 Individual deliverables


Categories Type of Product Commitment Owner Initiative Outcome

Functional foods Functional food AQUAPORINS&INGREDIENTS SL

New Food Productsenhancing theCognitive andPhysicalPerformance of theAging Adults -INNOVACTIVES

Plant (Func-B® Brassica Powder forFood Ingredients Patented for Europeand Japan and pilot production started in2014) and algae ingredients rich inbioactive compounds (Ongoingproduction at lab scale).

Healthy lifestylepromotion

A validated andrunning protocol

University ofValencia

Chronic diseasesprevention byimplementation ofhealthy lifestylehabits inpostmenopausalwomen - CARMEN

Demonstration of versatility and utilityof elastic thera-bands as useful tool toaccomplish the main objectives of eachexercise step in participants, and that maybe used for exercising independently athome.


Events - 47 walkingtours

U.S.ACLI Italy Getting OptimiseAgeing Life-quality -GOAL integratingwell-being, propernutrition andphysical activity:novel approaches to�ght and preventfrailty

In the �rst six months of 2014 USACLIorganized all over the country 47"Walking for Health".


Running protocol Institute ofBiomechanics ofValencia

Frailty preventionand delay throughfunctionalassessment of dailyactivities -BIOMECH4PREVENTION

Improvement of balance in older people.The exercises proposed can be performedat home as well as in nursing home.


Scienti�c Article University ofValencia

Psychosocial andpsychobiologicalapproach to preventage functionaldecline and frailty -AGEWELL

Report and published articles onIDOCALs study result on the capacity toevaluate and analyze retirementpredictors and study the motivation tokeep older people active at work.


Training courseswith a modular stepplan

Center forGastrology

Gastrologicalapproach onmalnutrition

Training for chefs who can lead theirkitchen team (on behalf of) envisagingthe maintenance/improving of the wellbeing and health of the elderly.

Knoweldgegathering/Dissemination

Accademic Trainingcourses & new onesforeseen & Scienti�cArticle

Faculty of Pharmacy,Universidade deLisboa(FF/ULisboa)

Health Ageing withInnovativeFunctionalFoods/Needs forDegenerative andMetabolic Diseases -INOVAFUNAGE-ING

Amodel to evaluateneuroin�ammation-associatedvulnerabilities by ageing was developedand recently published (Caldeira et al.Front Cell Neurosci 2014;37:94-9). Fourcourses were organized so far, all includedin the Master’s course/PhD program ofBiopharmaceutical Sciences for 20students, with the themes ofDevelopment and Organization of theNervous System, Brain Barriers in DrugDevelopment, Neuropathology andNeuropharmacology andPathophysiology of Neuroin�ammation.A new thematic network on glial cells isbeing developed between Portugal andBrasil, including the possibility ofcooperation for doctoral programs. Inaddition, a full year program is intendedto be developed in 2015 in accordancewith spsonsoring abilities, with specialtrimestral sessions devoted to the topicsof Ageing well, involving Socialoranizations, Clinics, PharmaceuticalLaboratories and Basic and AppliedResearch for systemic biomarkers.




Data Platform University ofMinho (UM), Lifeand Health SciencesResearch Institute(ICVS)

Promote healthybrain ageing bymodulation of riskbiomarkers

Establishment of data platform. Thestrati�cation of the risk of cognitivedecline will allow the early detection ofthose at higher risk and, therefore, theimplementation of a tailored preventionapproach with higher chances of success.


Guidelines andreccomendations

International Sportand CultureAssociation

ACTIVEAGE 1. Active Age Handbook: Capacitybuilding for physical activity of olderpeople. Recommendations - Guidelines -Practical tools to create and implementstrategies and programs in sportorganisations. 2. Creation of theEuropean Platform for Active Aging inSport (EPAS) These are all deliverables.


Questionnaireinvestigatingcorrelation betweencultural and socialactivities and frailtystatus

Federico IIUniversity andHospital NaplesItaly, FondazioneGENS Onlus

Getting OptimiseAgeing Life-quality -GOAL integratingwell-being, propernutrition andphysical activity:novel approaches to�ght and preventfrailty

Fondazione GENS Onlus incollaboration with the School ofMedicine of the University Federico II ofNaples. has developed and an ad hocquestionnaire to test the relation betweenengagement into cultural and socialactivities and well-being, resilience,adherence to diet, physical activities,diagnosed diseses and perceived healthstatus. The questionnaire has beenadministered to four di�erent groups:Movie clubs audience, beach resortclients, art metrotorur participants andcardio clinics out patients. By november2014, 850 questionnaires have beencollected and stored in a dedicated database. Gender distribution of thepopulation examind is 54% women an46%men. Mean age of the populatio is57,7 years and 438 subjects are over 60(mean age 68,45+ 7) representing 49% ofthe population examined. Preliminaryanalysis indicate that there is a direct andsigni�cant correlation betweenwell-being and cultural and socialengagement in both the over and under60 subjects.


Scienti�c Article Regione del Veneto TheMarco PoloInitiative: Using aMultidimensionalPrognostic Index -MPI and frailty.

International dissemination of the results.(www.mpiage.eu)

Knowledgegathering/Dissemination

Scienti�c Articles Aston University Healthy ageingmetabolism andnutrients

Scienti�c publication on the preventionof progression from pre-frailty to frailtyin older adults trought the study of thenutrient status of older adults withparticular attention to fatty acids andantioxidant nutrients.

Knowledgegathering/Dissemination

Twitter Account Agencia EstatalConsejo Superior deInvestigacionesCientí�cas (CSIC) -@nutretuoido

Social networks todisseminatenutritional habitsfor the elderly toimprove theirquality of hearing -@nutretuoido

A twitter account to increased awarenesson the importance of hearing impairmentfor active ageing, and on the impact ofnutrition on hearing loss (@nutretuoidoin Spanish and @targear in English). Theultimate goal of the project is to improvediet habits in order to prevent/delay theonset of age-related hearing loss, whilehaving an impact on the risk of falling.



Added value oftelemedicine forphysicalrehabilitation

PhD dissertation (6scienti�c papers)

Roessingh Researchand Development

Result of variouseuropean projectsaiming onpromoting physicalfunctioning inpatients withvarious chronicdiseases and olderadults

A scienti�c dissertation available for thelarge public

Screening tool Running protocoland scienti�cpublications

UNIFAI - Researchand Education Uniton Ageing / ICBAS -Institute ofBiomedical SciencesAbel Salazar -University of Porto

Frailty in old people:guidelines forassessment andintervention

A series of publications have beenproduced on the need to review andadapt existing instruments to measurefrailty and for estimating the prevalenceof frailty in the population in Portugal:By using the phenotype of frailty (Friedet al, 2001) as a golden pattern thefollowing two instruments have beenadapted: Groningen Frailty Indicator(GFI) (Schuurmans, H., Steverink, N.,Lindenberg, S., Frieswijk, N., & Slates, J.,2004). Tilburg Frailty Indicator (TFI)(Gobbens, van Assen, Luijkx,Wijnen-Sponselee, & Schols, 2010).

Screening tools App available Hanze University ofApplied SciencesGroningen (HanzeUAS)

EIP AHA actionplan Frailty ActionGroup

Quick and easy assessment ofmalnutrition and frailty (risk). The toolaims to enhance patient empowerment,promotion of independent living, earlydetection of (pre-)frailty or malnutrition(risk) prompting timely interventions.

Screening tools Screening Tool Regione del Veneto TheMarco PoloInitiative: Using aMultidimensionalPrognostic Index -MPI and frailty.

Implementation of prognostic index(MPI) as a Multidimensional assessmentinstrument before discharge of frailpatient from Geriatric wards to predictsurvival, health-related outcomes and toforecast health resource use and costs,driving the choice of health interventionsfor frail individuals that present the bestcost-e�ectiveness pro�le.www.mpiage.eu

Documents

The Action on