Ageing population is increasing worldwide to reach an estimated two billion people aged over 65 years by 2050, which will obviously affect the planning and delivery of health and social care. A consequence of age related decline is the clinical condition of frailty. Frailty is a medical syndrome with multiple causes and contributors that is characterized by diminished strength, endurance, and reduced physiologic function that increases an individual’s vulnerability for developing increased dependency and/or death . Frailty is characterized by multiple pathologies: weight loss, and/or fatigue, weakness, low activity, slow motor performance, and balance and gait abnormalities. There is also a potential cognitive component. Frailty makes elderly more vulnerable to stressors and has major health care implications, such as increased risk of incident falls, delirium, worsening of mobility, disability, hospitalization, institutionalization, and mortality which eventually increase the burden to cares and costs to the society.

The European Union has placed specific importance on defining frailty, as frail persons are high users of community resources, health services, and nursing homes. It is assumed that early intervention with frail persons will improve quality of life and reduce health services costs. Frailty is a clinical entity distinct from disability and co-morbidity. Disability is measured by impairment in activities of daily living (ADL) and co-morbidity is defined by the presence of two or more diseases. However, all three conditions, often referred to as geriatric syndrome, are predictive in varying degrees of adverse health out-comes, and therefore have a certain level of overlap, and this increases with greater frailty.

A single operational definition of frailty has not been agreed so far, as experts in a recent consensus conference have failed to agree1. The lack of standardized definition of frailty causes heterogeneity in studies. Frailty as a syndrome is characterized by a cluster of symptoms and signs that can be grouped in a physical, cognitive, functional, and social domain. Of these domains, the physical frailty phenotype is more studied and described by weight loss and sarcopenia, weakness with low grip strength, exhaustion or poor endurance, slow motor performance (e.g., slow walking speed, decreased balance) and low physical activity, as a marker of low energy expenditure . The cumulative deficit model provides an alternative operational definition of frailty. It is based on a comprehensive geriatric assessment and takes into account ninety-two baseline parameters of symptoms, signs, abnormal laboratory values, disease states and disabilities, referred as deficits, to define frailty . The derived Frailty index is a simple calculation of the presence or absence of each variable as a proportion of the total, thus frailty is defined as the cumulative effect of individual deficits. However, the Frailty index does not distinguish frailty from disability or comorbidity; instead, it includes them.

Frailty together with functional decline and disability are common conditions in older people, and are increasing with ageing. However, frailty is a dynamic and not an irreversible process; it seems preventable, may be delayed, or reversed. Transition between frailty states, i.e., non-frail, pre-frail, frail, has been documented . It is more likely to progress from the non-frail status to frail than the opposite. The rate of progression varies among elderly and some cases show sudden onset and rapid transition, whilst others slow and progressive changes. Interventions that alter the natural course of frailty may prevent or reduce adverse health outcomes, and thus, may be proved beneficial not only to individuals, but to families, carers, and society. Moreover, frailty is believed to be preceded by behavioral adaptation made in response to declining physiologic reserve14. Behavioral changes may precede the transition to pre-frail or frail state and often pass undetected. More importantly, such changes may not be captured by conventional clinical assessments. A recent comprehensive overview of existing frailty measurements has identified 27 measures of frailty, but none of them have been recognized as a gold standard  and half of them have not ever been used by other investigators.

Considering that frailty has major health care implications and all persons older than 70 years should be screened for frailty1, FrailSafe addresses all of the above challenges, i.e., lack of an agreed single operational definition of frailty, lack of a reliable frailty model, understudy of cognitive, functional, and social domains in addition to the physical domain of frailty, the fact that behavioral changes may precede the transition to pre-frail or frail, the need to develop real life tools for the assessment of physiologic reserve and the need to test interventions that alter the natural course of frailty since frailty is a dynamic and potentially reversible process.

FrailSafe aims to better understand frailty and its relation to co-morbidities; to identify quantitative and qualitative measures of frailty through advanced data mining approaches on multiparametric data and use them to predict short and long-term outcome and risk of frailty; to develop real life sensing (physical, cognitive, psychological, social) and intervention (guidelines, real-time feedback, Augmented Reality serious games) platform offering physiological reserve and external challenges; to provide a digital patient model of frailty sensitive to several dynamic parameters, including physiological, behavioural and contextual; this model being the key for developing and testing pharmaceutical and non-pharmaceutical interventions; to create “prevent-frailty” evidence-based recommendations for the elderly; to strengthen the motor, cognitive, and other “anti-frailty” activities through the delivery of personalised treatment programmes, monitoring alerts, guidance and education; and to achieve all with a safe, unobtrusive and acceptable system for the ageing population while reducing the cost of health care systems.

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