Project Overview

To improve the identification, prevention and management of frailty and care of multimorbidity in community dwelling persons (over 65) of loco-regional settings of EU countries.

Population ageing is accelerating rapidly worldwide, from 461 million people older than 65 years in 2004 to an estimated 2 billion people by 2050, which has profound implications for the planning and delivery of health and social care. Two of the most problematic expressions of population ageing are the conditions of frailty and multimorbidity.

Frailty is often conceptualized by health care providers as a state of late life decline and extreme vulnerability characterised by weakness and decreased physiologic reserve. Frailty contributes to increased risk for falls, institutionalisation, disability, and death. Multimorbidity, the contemporary presence of two or more chronic medical conditions in the same person, is more frequently found in the ageing population.

Studies performed during the last 20 years have progressively demonstrated the importance of the concurrence of multimorbidity and frailty. This poses new challenges to health services, in terms of professionals’ skills, resources and organisational aspects.

SUNFRAIL (SUNFRAIL Reference Sites Network for Prevention and Care of Frailty and Chronic Conditions in community dwelling persons of EU Countries) is a European project with a duration of 30 months, which started in May 2015. The project receives funding from the EU Health Programme 2014-2020 and brings together 11 partners from 6 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.

This will be achieved through:

• The design of an innovative, integrated model for the prevention and management of frailty and care of multimorbidity.
• Validating the model on the basis of existing systems and services (and related good practices).
• Assessing the potential for the adoption/replication of the model/good practices in different European organisational contexts.
• Promoting the dissemination of the results with a focus on strategic decision-makers at regional, national and EU level to support the adoption of effective policies for the prevention and management of frailty and care of multimorbidity.

• Develop a shared model of references on frailty and multimorbidity.
• Develop innovative toolkits for the prediction of frailty and multimorbidity by level of care, focusing on community based prevention and avoidable hospitalisation. The toolkits will focus on the four following areas:
  1. Assessing the risks of frailty through physical and performance measures
  2. Supporting the design of care pathways for the management of chronic diseases
  3. Identifying methods and instruments to predict multimorbidity
  4. Identifying instruments for workforce development and cost analysis.