On 7th of February, the 4-year SUNFRAIL Project was concluded by its Final Conference in Bologna, Emilia-Romagna Region, Italy. The final conference gathered regional health authorities, local and regional stakeholders, policy makers and SUNFRAIL project partners to present and discuss the SUNFRAIL project’s result, opportunities, replicability and outcomes. The SUNFRAIL Project have successfully succeeded in developing a SUNFRAIL Model for frailty, a SUNFRAIL tool for early detection of frailty, and a SUNFRAIL human resources tool for training of health professionals. Ms Elisabetta Gualmini, Minister of Welfare Policies in Region Emilia-Romagna, opened the SUNFRAIL Final conference by addressing the demographic change challenge and the importance of early detection of frailty. In the session of “Initiatives to address frailty and multimorbidity” existing networks and actions to address frailty was presented to participants, such as the network of Italian regions Pro.M.I.S (PROgramma Mattone Internazionale Salute) and the AdvantAGE JA. Ms Mirca Barbolini, Coordinator of the SUNFRAIL Project from the Regional Agency for Health and Social Care in the Emilia-Romagna Region, presented the project results and outcomes by addressing the elements of success regarding the SUNFRAIL tool; 1) Understandable, 2) Easy to use by professionals, and community actors, 3) Empowering beneficiaries 4) Connecting services (health, social, community care), 5) Multidisciplinary approach to frailty. Final recommendations regarding opportunities and replicability of the SUNFRAIL projects outputs were drafted by EUREGHA Chair Nick Batey during the conference as follows: ·         Reinforce the message to policy makers across Europe that frailty is a reversible condition, and needs to be addressed through its main dimensions and early identification of risk factors, to orient proactive and preventive strategies. (European, national, regional and local health authorities) ·         Move beyond the hospital setting that frailty alerts can be identified especially in community and primary care settings, targeting a population that may be unknown by services. (National, regional and local health authorities) ·         To address frailty in a sustainable way requires broad interdisciplinary approaches and integrated strategies connecting existent health, social and community services. This should be embedded in funding approval projects (National, regional and local health authorities) ·         Adopt a more holistic consideration of we mean by frailty e.g. bio/psycho/social aspects ·         Don’t underestimate the challenge of implementation. Use the evidence to create a compelling local story and use existing structures to drive adoption where possible (local authorities) ·         Use structures to accelerate good practices exchange (EU networks and national agencies- EUREGHA, PROMIS, Reference site collaborative network, etc) ·         Addressing reversible frailty is an issue relevant to an increasing proportion of European population. It will be greater added value in addressing this at EU level. Please find more information about the SUNFRAIL Project on the website. SUNFRAIL (Reference Sites Network for Prevention and Care of Frailty and Chronic Condition in community dwelling persons of EU Countries) is a European project with a duration of 30 months, which started in May 2015. The project received funding from the EU Third Health Programme 2014-2020 and gathered 11 partners from 6 EU Member States.  

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On 27 October, SUNFRAIL partners and externally invited speakers gathered in Naples for the 2nd transnational workshop “Toward a Bio-Psychosocial model of frailty”, hosted by Azienda Ospedaliera Universitaria Federico II. EUREGHA, as consortium partner of the project, was represented by EUREGHA Vice-chair and EUREGHA Secretariat. After the opening speeches, introduction of the general objectives and first results of SUNFRAIL project were presented.

The first session further focused on the evolution of the concept of frailty from a physical state to include social and psychological domains. The second part of the morning session was dedicated to showcase good practices on identification of frailty and multimorbidity collected by all partner organisations.

The highlight of the meeting was the presentation of SUNFRAIL tool on frailty and multimorbidity. A questionnaire containing 9 questions was developed to assess three domains of frailty: biological, social and psychological. Each question response is thought to generate an initial alert leading to a specific response according to the conditions and domains identified.

The afternoon session was enriched with in-group discussions on the main points: how to identify frailty through health, social and community care services;  how to operationalise a response on frailty and multimorbidity; how to respond to lifelong learning needs and which innovative business models to prevent frailty could be adopted.

Some of the main points and conclusions from the workshop were:

• Frailty is considered to be a low priority issue for most general practitioners, due to high cost of prevention and its perceived limited clinical relevance;
• While the general practitioner is one of the main entry points and the point of referral for the detection of frailty and for the implementation of the first interventions, other professionals (nurses, social workers, others), play an important and complementary role;
• Since frailty is a complex multi-domain condition, it is important to involve and train professionals with a multidisciplinary approach;
• In order to address the elderly’s need to maintain their independence and bridging the gap between services provision and utilisation, it is important to improve awareness about frailty risk factors and to promote preventive activities, as well as to support professionals in adopting effective communication and promotion means.

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EUREGHA Secretariat attended the SUNFRAIL Transnational Workshop in Bologna on 22 mars. SUNFRAIL is a project co-funded by the EU Health Programme 2014-2020 that involves 11 partners from six EU Member States. The project aims at improving the identification prevention and management of frailty and care of multimorbidity in community dwelling persons (over 65) of loco-regional settings of EU countries. SUNFRAIL kicked off in May 2015 and will run for 30 months.

Frailty, sometimes broadly defined as an increased vulnerability to stressors, is a condition associated with ageing and which is in various ways linked with the existence or emergence of chronic diseases and multimorbidity. Given the EU’s growing ageing population and the pressure on health and social care systems, frailty has emerged as a topic on the EU health policy agenda.

Experts from the project partner organisations, as well as externally invited speakers, gathered for the full-day event to discuss the scientific definitions and models of frailty and multimorbidity as well as how the scientific knowledge can be appropriately translated into effective policy responses in loco-regional settings.

During the first session, experts discussed different prevailing definitions and assessment tools of frailty and pre-frailty, ranging from models primarily understanding frailty as a biophysical condition to broader definitions also including psychological and social factors.

This was followed by a session on the creation of synergies between the SUNFRAIL project and other similar European initiatives and projects, such as the EIP-AHA, Joint Action CHRODIS, FRAILCLINIC, FRAILTOOLS and the Simpathy project.

The last session was devoted to group discussions on how to develop an operational response to frailty and multimorbidity and on good practices and tools for the identification of frailty and multimorbidity.

Some of the main points and conclusions from the workshop were:

• Detecting and managing frailty to be able to activate preventative measures for avoidable disabilities and hospitalisations may increase cost-efficiency of health systems.

• A holistic understanding of frailty is desirable, incorporating not only physical variables, but also taking into account psychological and social signs and determinants.

• Due to the abundance of models and tools on frailty, focus should be put on assessing and sorting among them, rather than inventing a new model from zero.
• It is important to raise awareness about age-related conditions among both policy-makers, health authorities, and the general population.

• Providing training in frailty recognition to health- and social care staff is a crucial factor and an important step in a better response to frailty

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As a partner and leader of the work package on dissemination, EUREGHA attended the kick-off meeting of the SUNFRAIL project on 27-28 May.

The SUNFRAIL project aims at improving the identification, prevention and management of frailty and care of multimorbidity in community dwelling persons of loco-regional settings of EU countries.

This will be achieved through the development of a multi-modal model, with a common core to facilitate scale-up and adaptation to the specificities of different health care systems and to different sociocultural contexts. Once the model has been developed and validated, it will be experimented in different settings to ensure its applicability and transferability to various loco-regional settings. The project will also support the identification of tools for the prediction of frailty and multimorbidity by  level of care, focussing on community based prevention and avoidable hospitalization, and for professionals’ skills improvement and analysis of costs.

SUNFRAIL is the first project to receive funding under the third Public Health Programme. The project will run over 30 months and gathers 11 partners from 6 countries, whereof 7 partners are Reference Sites in the EIP-AHA. The project is coordinated by Emilia-Romagna Region.

Presentations from all the work packages will be available shortly.

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