Societal and health challenges

According to the 2015 EU Ageing Report, demographic ageing in European population will change dramatically over the coming decades. The percentage of citizens aged over 65 years is predicted to rise from 18% in 2013 to 28% by 2060 and the percentage of people aged 80+ will increase from 5% to 12% during the same time period.

Frailty is considered as one of the most complex and important issues associated with ageing. It is considered as a condition of diminished physiological reserves, that put the individual to a greater risk of a less efficient response and functional recuperation in case of exposure to stress and thus adverse health outcomes (e.g. hospitalisation, fall, disability). The syndrome has significant repercussions on the older persons’ quality of life and on the health care system1. The relationship between frailty and a higher risk of falling, loss of functional independence, reduced quality of life, institutionalization, and mortality2, 3, has been well-documented.

Frailty is not an inevitable consequence of ageing. In many cases it can be pertinently managed and its evolution can be delayed or even postponed; thus a stronger focus on early screening and detection of frailty is needed for timely management4 and prevention of loss of autonomy.

1 Frailty in older adults: evidence for a phenotype. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA, Cardiovascular Health Study Collaborative Research Group. J Gerontol A Biol Sci Med Sci. 2001 Mar; 56(3):M146-56.
2 Frailty and risk of falls, fracture, and mortality in older women: the study of osteoporotic fractures. Ensrud KE, Ewing SK, Taylor BC, Fink HA, Stone KL, Cauley JA, Tracy JK, Hochberg MC, Rodondi N, Cawthon PM, Study of Osteoporotic Fractures Research Group. J Gerontol A Biol Sci Med Sci. 2007 Jul; 62(7):744-51.
3 Psychological well-being and incident frailty in men and women: the English Longitudinal Study of Ageing. Gale CR, Cooper C, Deary IJ, Aihie Sayer A Psychol Med. 2014 Mar; 44(4):697-706.

The EU FrailSafe Solution for frailty prevention

EU FrailSafe offers an integrated assessment system, using cutting-edge technology. The solution estimates people’s frailty level and locates a person’s weakness in order to provide personalized suggestions. It also provides a health monitoring tool and has the potential to generate real-time notifications in case of adverse events. The solution complements traditional clinical assessments in identifying those at higher risk of developing adverse health events, and thus facilitating comprehensive integrated care plans for older people.

How does it work?

Frailty assessment and monitoring is done through traditional clinical assessment and a set of devices and technologies, such as:

Indoor/outdoor monitoring and localization

Virtual Augmented Reality /Serious games

Traditional clinical assessments

The developed system collects and analyses data from different domains including physiological, cognitive. behavioural, psychological, social, enabling the system to estimate the frailty level of a person. It generates a virtual patient model (VPM) that reflects a person’s current health status and suggests personalised frailty preventive interventions.

Alongside this process, health care professionals can visualize their patients’ health data through the EU FrailSafe Platform and take actions if deemed necessary. Not only health professionals but also older individuals themselves and their authorized family members can view their data through the Platform’s dashboard and therefore monitor different parameters of their own health.

Click here to have an insight in the technical system.

Why should you use the EU FrailSafe Solution?

Older person and informal carers

Medical professionals

Researchers and policy-makers

Older people can use the platform to have an overview of their health data collected in real-time. They can visualize data related to their current health status and act, where necessary, to strengthen the spotted weakness thanks to the personalized recommendations. This enables them to remain independent, active and maintain their quality of life as long as possible by adopting a preventive approach. Moreover, the system also enables informal carers to remotely monitor relevant variables (such as physiological measurements) and alert them of any deviations.. It can empower prefrail individuals in their homes and communities, increasing their autonomies, and consequently also the informal carers’ quality of life. Finally, health professionals can also be given access to the medical data of their patients and will thus be able to monitor the older person’s progress and provide them with a comprehensive care pathway.

Click here to see an interview with an older person on the importance of prevention.

Click here to read an interview with the Executive Director of Eurocarers, an NGO representing informal caregivers.

Frailty evaluation and management is a challenge in geriatrics. Nowadays, health professionals are limited in monitoring the evolution of frailty and above all, detecting frailty accurately, efficiently and early enough so older people can preserve their functional autonomy as long as possible.

Considering the abovementioned challenges, the FrailSafe solution supports medical professionals in detecting frailty earlier using a more accurate and comprehensive approach, allowing for preventive measures to be applied in time and delaying the onset of frailty among their older patients. Finally, by having access to their patients’ real-time daily data and their medical history, medical professionals are able to better adapt their treatments.

Click here to listen to how the FrailSafe solution can help medical professionals.

Due to the vast amount of available real-life measurements vital signals and medical data collected via the utilised devices and other clinical assessment substantial research can be conducted based on this anonymized data. This will aim at the advancement of science towards long-term detection, delay, prevention and treatment of the frailty syndrome. Data scientists, medical researchers and social workers might use the existing available data in order to uncover and design high-level theories which structurally correlate the data and propose relevant policies to prevent the consequences of frailty.

In this direction, regional or national policy-makers can contribute by coupling the research results with social features and political will in order for the suggested policies to be tried in communities or regions and later be implemented as a general policy in the public domain.

Listen to the interview of a former supervisor in the Social Welfare Services of the Ministry of Labour and Social Insurance in Cyprus.

Healthcare organisations

Pharmaceutical companies

Insurance companies

Healthcare institutions are looking for ways to reduce treatment costs.

The EU FrailSafe solution can be applied to their patients on a regular basis for screening and evaluation purposes. The system will give healthcare organisations the opportunity to reduce monitoring and treatment costs for older people’s frailty-related diseases, increase the availability of their resources and expand their services to existing or new patients by providing high quality services.

Listen to our care provider partner’s opinion on how the EU FrailSafe solution can improve their services.

Pharmaceutical companies can use the EU FrailSafe solution to accompany research for frailty-related drugs or treatments from the stage of sample selection up to the final results validation. The system can help pharmaceutical companies assess their products using an innovative and reliable method.

The costs of in-hospital treatment and rehabilitation for older patients are covered by their insurance company, be it public or private. Insurance companies can recommend to the use of the EU FrailSafe solution for prevention purposes to their clients. A large percentage of preventable incidents are related to frailty-related diseases, therefore it is in the insurance company’ interest to reduce these costs by using a system that detects frailty early and provides personalized prevention measures.

Listen to two insurance companies experts’ opinion on how the EU FrailSafe solution can improve their services.

Additional information

What makes EU FrailSafe innovative?

Click here to see the infographic.

Our solution for frailty prevention

Click here to see the infographic.


Professor Stefania Maggi is serving as the Ethics Supervisor of FrailSafe. Prof. Maggi is a Geriatrician and Epidemiologist with expertise in both areas of Clinical Geriatrics and Epidemiology of Aging. Her research focuses on the epidemiology of aging and on the analysis of the impact that lifelong health promotion and disease prevention programs have on healthy aging. She is a Board-Certified Geriatrician (University of Padua, Italy) and also obtained a Master in Public Health in Epidemiology in 1987 and completed a two-year Post-Doctoral Training in Epidemiology, both at the Johns Hopkins University, in Baltimore, MD, USA. Prof. Maggi was the Coordinator of the Program for Research on Aging of WHO, from 1990 to 1993, based at NIA, NIH, Bethesda, MD, USA. She is currently working as Research Director at the CNR Aging Branch-Institute of Neuroscience in Padua and is the Director of the CNR Project on Aging, involving 22 multidisciplinary, research centers in Italy. Over the year, Prof. Maggi has created a large international network, leading to the implementation of cross-national research projects. Since 2001 she is a member of the Board of Directors, American Federation for Aging (AFAR), New York, NY, US, and since 2010 Director General of the Mediterranean Diet Foundation. Prof. Maggi has been the Academic Director and is currently the President of the European Union Geriatric Medicine Society (EUGMS). She is the author of about 300 publications in international journals of Medicine and Public Health and is Editor in Chief of Aging Clinical and Experimental Research.


What is the frailty syndrome?
Frailty is a biological syndrome of decreased reserve and resistance to stressors, resulting from cumulative declines across multiple physiologic systems and causing vulnerability to adverse health outcomes. Frail older people display low resilience to minor stressors (e.g. urinary tract infection). Adverse health outcomes include disability, morbidity, falls, hospitalization, institutionalization, and death. Frailty is a dynamic and not an irreversible process; it seems preventable, may be delayed, or reversed.

Which are the baselines of operation of the FrailSafe project?
FrailSafe tries to delay the effects of frailty or even reverse the progress of the syndrome by using data generated by patients during their daily life (e.g. collected via wearable devices) and an advanced online platform which analyzes this data and suggests interventions.

Describe the FrailSafe solution; How is the project going to solve the problem?
FrailSafe aims to delay or reverse the effects of frailty by using advanced technological devices to monitor patients' daily life. By continuously collecting user-generated medical data of multiple sources (physical, cognitive, behavioral, psychological, social, etc.), the FrailSafe system can complement the comprehensive geriatric assessment by analyzing and quantifying the frailty level of each person and hence provide suggestions for personalized interventions based on each person’s condition. The interventions are provided through a suite of serious games (some of which are virtual and augmented reality) challenging accordingly physical, cognitive, psychological, functional and social domains, through recommendations regarding lifestyle, daily activity, exercise, nutrition etc., by providing assistance to comply with medical recommendations and facilitating the adjustment of drugs or drug dosage by the physician based on the objectively measured parameters.
Additionally, a new frailty measure that is quantitative and qualitative is being developed. Real-time data processing enables the FrailSafe system to immediately detect dangerous and emergency events (e.g. falls, loss of balance, loss of orientation etc.) and alert people’s families, their personal caregivers and the emergency department via suitable messages.

What are the advantages of the FrailSafe solution? Describe what is innovative in the project idea.
The project is based on real-life medical data which are continuously generated using wearable devices, unlike other solutions which use one-off medical data, not always representative of the patients' condition.
The big shift compared to other similar solutions is the innovative back-end platform which processes and analyzes all personal data using deep-learning algorithms which can quantify people’s frailty level and locate the weakness areas of each person in order to provide personalized suggestions.
Moreover, other solutions do not consider all the domains we consider in FrailSafe, i.e., physical, cognitive, social, behavioral physiological, psychological. A great advantage of our solution is that it relies on a novel frailty metric that can be used to predict short and long-term outcomes and risk of frailty.

Who is the targeted customer paying for the FrailSafe solution, e.g. patient, hospital or care center, insurance companies etc.?
The main customers are expected to be the medical professionals (hospitals, clinics, doctors etc.) who will be given access to the platform to monitor their patients' medical data and assist them in dealing with their syndrome, along with health insurance companies who will greatly benefit by reducing their costs and liabilities due to significant drop in hospitalization, institutionalization and social care expenses derived from early detection and prevention of frailty symptoms.
Ultimately, health insurances and the public and private health system can pay the foreseen expenses since they will benefit from the prevention of adverse health outcomes of older people. Healthcare staff needs to get involved to overview the daily activities, check the uploaded data, suggest the most appropriate interventions given the data collected, monitor the results of interventions, execute physical exams, etc.
Secondarily, some additional options will be given to users/patients on a paid subscription for advanced features and services, e.g. advanced features for data visualization.

Which is the followed monetization strategy? What exactly do users pay for? Is it just the mobile app, the data coming out of it etc.? Are any additional services offered on top of them?
Monetization is done through selling access to the FrailSafe platform which provides all the features to both end-users and medical professionals. Older people and their families (end users) will greatly benefit from continuous remote monitoring and saving time from frequent in-person checkups, while medical professionals will be assisted by the FrailSafe solution in their treatment suggestions and have large amounts of data for better assessment. An additional business model has been designed for long-term perspective, where only (anonymized) data will be provided to third parties who wish to access data sets collected in real-life conditions to inform their own projects (the platform's medical data after 2-3 years with thousands of patients' data). This model will be suitable for insurance companies, researchers etc.

How many users are required for the solution to make sense economic wise? Which is the volume of data points which guarantee data validation?
A rough estimation is that an initial customer base of 5.000 older people (4.500 free accounts plus 500 paid monthly subscriptions) and 50 medical professionals/insurance companies (all of which with paid subscriptions) will make the app business financially viable and will provide a broad enough data sample for the deep-learning algorithms to be trained in order to provide validated results.

Are there any competitors doing the same thing with the FrailSafe solution? How do you envisage to differentiate?
There are numerous projects/systems dealing with innovative ways to detect geriatric issues (including the frailty syndrome) using ICT devices. To our knowledge, what makes FrailSafe unique is that it employs both physical medical data (collected via wearable devices) and data analysis of other sources of older people's activities (psychological, behavioral etc.) in order to measure their frailty level and monitor progress. Additionally, this analysis is not static, but continuously re-evaluated using other people's data to self-assess the accuracy of the method.
The main differentiation of FrailSafe compared to other developed/developing solutions is its real-time data capture which eliminates the need for older person to frequently visit her/his personal doctor but being assured that both the doctor and the system are remotely monitoring her/his condition 24/7. Furthermore, the feature of automatic instant alerts (to family members, caregivers, doctors, nurses etc.) in case of life-threatening adverse events (falls, loss of balance, loss of orientation etc.) might be life-saving for many older people. The global results of the adoption of the FrailSafe solution would be to eliminate the cost for both society and individuals and improve the daily life of older people.

What is the value proposition for each targeted user group?
The value proposition for individual patients include real-time data monitoring and alerts, personalized suggestions for interventions based on their condition, real-time communication with their doctors or other patients via the online platform etc. For medical professionals, the value proposition is based on the possibility to have real-time access to their patients' daily data and have their entire medical history available at any time for better adaptation of their treatment. Additionally, FrailSafe will act as their marketplace for acquiring new customers/patients who need the advanced monitoring capabilities offered by the online platform.

Have you conducted a cost-benefit analysis? What are the estimated savings for the healthcare system, the society, the patients etc.?
A representative example follows: It is estimated that the cost of falls alone in older people due to frailty syndrome in the EU is more than 40 billion euros on an annual basis, which includes hospitalization expenses, social services cost and rehabilitation cost. This cost is covered by the national health system, the private sector (e.g. insurance companies) and individuals themselves. The target of the FrailSafe solution is to lead to a significant reduction in falls among those equipped with the FrailSafe solution, the vast majority of which occur at home and, thus, result in significant cost reduction for fall-related injuries alone. This is expected to be made possible through the early detection of increased frailty levels in older people far earlier that it is possible today using the traditional methods. Additionally, deep data analysis will produce personalized suggestions for improvement of fields that each person is weak at, e.g. foot exercise in case of low gait speed. All these innovative features are estimated to have a large impact on the way frailty is treated and people are ageing.

FrailSafe Objectives are divided into Medical (MOs) and Technological Objectives (TOs). TOs concern the development of an ICT solution that will deliver rehabilitation, and ultimately lead to prediction, prevention and self-management of frailty symptoms.

The main technological objectives (TOs) of FrailSafe are:

  • TO1. Design and development of hardware components (ambient and wearable sensors, body node coordinator (e.g., smart phone) optimised in terms of ergonomics, user-friendliness compactness, unobtrusiveness and energy consumption that can be used indoors and outdoors providing functionalities for effective yet simple and economical personalized monitoring of the individual patient's condition for purposes of detecting/alerting/averting of frailty events, merged to an integrated system, explicitly taking into account security and privacy issues.
  • TO2. Design and development of efficient signal processing algorithms for low level processing including signal enhancement, activity classification, energy expenditure, and behavioural monitoring.
  • TO3. Development of a self-adaptive virtual patient model offering optimal services for managing frailty ranging from critical situation management, facilitating social integration to day-to-day self-management and health preservation based on a personalized patient profile.
  • TO4. Development of a generic monitoring and management infrastructure on which modular services and patient-specific applications will be built.
  • TO5. Development of novel methods for the offline management, fusion and analysis of multimodal and advanced technology data from social, behavioural, cognitive and physical activities of frail older people and application of these methods to manage and analyze the large amounts of data collected leading to integrative interpretation and better understanding of frailty, introduction of new quantitative frailty biomarkers as well as frailty metrics, correlation of co-morbidities and frailty, advanced decision making capabilities (DSS) assisting diagnosis by medical professionals.
  • TO6. Development of real-time data management and data mining methods effectively making decision assessing frailty levels, detecting frailty risks and triggering alarms in case of emergency situations (e.g., fall, loss of orientation, incoherent utterances in electronic written text) based on minimal processing of real-time multi-parametric streaming data and economical personalized monitoring guided by a minimal number of sensors and parameters (FrailSafe prediction engine and Risk Factor Evaluation).
  • TO7. Investigation of processing time, storage and communication trade-offs for real-time analysis at the WBAN or the phone/PDA and use of data reduction and summarization techniques for reducing raw streaming data to secondary or tertiary parameters. Effectively use virtual patient models and results from the offline data mining of multi-parametric data to make real-time analysis more efficient and targeted.
  • TO8. Development of a dynamically synthesized, personalized and highly innovative Augmented Reality game consisting of different scenarios that will take place in the real world than in a virtual one that measures parameters of behavioural, cognitive and physical domain while implementing various intervention strategies.
  • TO9. Extensive testing of the FrailSafe integrated system in several validation scenarios while ensuring compliance with ethics standards.

Other objectives of FrailSafe are:

  1. Development of effective means for translating intensive non-pharmacological interventions at home settings.
  2. Encapsulation of pharmacological interventions when needed, for prevention or treatment reasons.
  3. Reduction of the effort needed for the provided healthcare service as well as load of carer and the overall cost spent for the healthcare system in Europe.

In summary, the fusion of the relevant information from all the sources mentioned earlier, is expected to advance our understanding of frailty and the associated co-morbidities, measure risk of frailty, and as such, risk of adverse outcome, provide a model for testing interventions and treatments, provide a model to deliver rehabilitation, and ultimately lead to prediction, prevention or even reversal of frailty.

FrailSafe will not only increase confidence in detecting frailty symptoms and signs, but also will improve motor and cognitive capabilities of older people by providing them with assistive visual and contact feedback while performing dynamically synthesized Augmented Reality games/rehabilitation programs. FrailSafe will develop an infrastructure on which novel patient-specific services will be integrated in a modular form. The service applications will manage and analyse large volumes of acquired and new multimodal and advanced technology data of older adults and individuals clinically diagnosed with frailty, and further relate the presence of frailty with the possible existence of specific co-morbidities if indicated by the caregiver. Aiming to design personalized, medically efficient and economical e-health services that will improve the self-management of older people, FrailSafe will support their overall health status, and strengthen their social activity. It will also provide means aiding their independent living, ensuring adherence to pharmacological treatments and offering at-home intense non-pharmacological interventions for maintaining/enhancing their cognitive and motor functionalities.

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