1 Authors Nick Guldemond, AG A2 Coordination Team Chair Maite Ferrando, AG A2 Promoter 2015-2016 (CSA PROEIPAHA) Valentina Tageo, AG A2 Secretariat Support Service 2015-2016 (CSA PROEIPAHA) With many thanks to all the AG A2 Partners who provided inputs, data and suggestions for this publication. Disclaimer The information and views set out in this publication are those of the authors and do not necessarily reflect the official opinion of the Commission. The Commission does not guarantee the accuracy of the data included. Neither the Commission nor the Action Groups may be held responsible for the use which maybe made of the information contained therein. European Union, 2015. All rights reserved. Certain parts are licensed under conditions to the EU. Reproduction is authorised provided the source is acknowledged.
2 Table of Contents 1 Executive Summary 3 2 Rationale of Personalized Health Management and Falls Prevention Action Group 4 3 Action Group Description 5 3.1 Role and Objectives 5 3.2 Governance & Coordination 5 3.3 Structure 6 3.4 Action Areas of the AG 6 4 Activities & Achievements 7 4.1 General Results 7 4.2 Achievements 7 4.2.1 Individual Commitments 7 4.2.2 Collaborative Work 7 4.3 Key messages and lessons learned 9 5 Conclusions and Future Activities 11 6 Annexes (only for online/digital version) 12 List of Figures Figure 1. Scope of the AG A2 and its links with other AGs within the EIP on AHA initiative 3 Figure 2. The falls prevention and management pathway 4 Figure 3. Key outputs and main goals of AG A2 5 Figure 4. Governance structure of the AG A2 5 Figure 5. Structure of the Action Group by Type of Partner 6 Figure 6. Country composition of the Action Group 6 Figure 7. Action Areas of the Action Group A2 7 Figure 8. Practices in falls prevention and management collected in AG A2 8 Figure 9. Relevance of the new 11 priorities for the AG A2 partners 11
3 1 Executive Summary The Action Group Falls prevention and management The Falls Prevention and Management Action Group (AG A2) brings together local, regional and national partners (health and social care, academia, public, private and third party organisations) from across the European Union who are committed to the implementation of evidence based validated and operationals programmes for prevention, early identification, minimisation of risk and management of falls in older people. The commitments Two calls for AG A2 commitments (measurable engaged stakeholders) were sent out by the European Commission in 2012 and 2013. Almost 200 stakeholders responded, including two thematic networks. Commitments represent stakeholders who are engaged within the partnership and who have both been directly involved in the development of the Action Plan and its ongoing delivery. Falls prevention and management Falls among older people is a complex and costly problem, and is ideally addressed though an integrated approach with timely and targeted prevention, screening, intervention and monitoring, which requires a multi-disciplinary, multi-agency and multi-level approach. This integrated care approach requires effective and reliable communication and coordination between the different professionals, informal carers and the individual. Information and Communication Technologies (ICT) are indispensable for efficient information sharing and decision making as well as training and education. The central objective of the A2 Action Group is to deliver EU wide evidence based validated and operational programmes for prevention, early identification and minimisation of risk and management of falls in order to contribute to the objectives of the EIP by reducing falls and the personal, system and societal consequences of fall-related injuries. These programmes are based on integrated care principles and complement other preventive actions on frailty and co-morbidity addressed by other Action Groups (figure 1). These are supported by the widespread application of awareness raising, education, training, collaborative research and innovative use of technologies. Figure 1. Scope of the AG A2 and its links with other AGs within the EIP on AHA initiative
4 2 Rationale of the Personalised Health Management and Falls Prevention Action Group Amongst the many threats to health and well-being of older people, falls are a significant cause and contributor to morbidity, disability and premature death. Indeed, falls are a major indicator of increasing frailty and loss of independence and mobility. One-third of people over the age of 65 who live in the community fall each year and this proportion increases to 50% of those aged 80 years and older. Falls among older people is a complex and costly problem, ideally addressed through an integrated approach with timely and targeted prevention, screening, intervention and monitoring. It therefore necessitates a multidisciplinary, multi-agency and multilevel approach. This integrated approach requires effective and reliable communication and coordination between professionals, informal carers and the elderly. Information and Communication Technologies (ICT) are indispensable for a supportive information flow and shared decision making as well as training and education. As a result, the EIP on AHA embedded the Personal health management, starting with a falls prevention initiative launching validated and operational schemes for early diagnosis and prevention of falls as a key theme in its Strategic Implementation Plan (SIP). The operational plan (Action Plan) was launched in 2012 in which the rationale, the objectives and the expected outcomes were described: a roadmap bringing partners of AG A2 together for coordinated efforts to implement falls prevention and management programmes at an EU level. Figure 2. The falls prevention and management pathway
5 3 Action Group Description 3.1 Role and Objectives The Action Group A2 aims to reduce falls by connecting research to innovation, ensuring early market uptake of new technologies for falls prevention by strengthening procurement processes. The Group also supports the set-up of regional programmes for early prediction and prevention of falls through the adoption of an integrated approach. 3.2 Governance & Coordination On an operational level, the work of A2 is performed by partners who are thematically organized in 4 Action Areas (AAs). All AAs are working collaboratively according to the overall Action Plan vision, objectives, actions and deliverables. The responsibility for each deliverable within an AA is assigned to the corresponding Deliverable Leader (DL) and supervised by an AA Coordinator. Figure 3. Key outputs and main goals of AG A2 Figure 4. Governance structure of the AG A2
6 The four AA Coordinators are represented in the Coordination Team (CT). The CT communicates at steering group level with the European Commission and is in charge of the formal communication with participants and external partners. Content related information from the team is communicated through the AA Coordinators (figure 3). 3.4 Action Areas of the AG As mentioned, the Action Group A2 is divided in 4 Action Areas (AAs) covering the following objectives respectively: 1. Implementation of an integrated and person-centred service pathway for fall prevention and management. 2. Gathering and analysis of data on implementation of evidence based interventions. 3. Awareness, information and education, to support the training of the workforce. 4. Governance: innovation, sustainability and scaling-up, including models for exploitation, business analysis and strategies for the take up of falls prevention technologies. Figure 5. Structure of the Action Group by Type of Partner 3.3 Structure The composition of Action Group A2 is heterogeneous (figure 5), with a relevant share of research organisations (43%) and health providers (25%), but also a representative sample of Public authority (12%), industry (10%) and advocacy or umbrella organization (10%). The Action Group A2 covers a wide range of European regions (figure 6), with some countries showing a high number of commitments on falls prevention (e.g. Spain, Italy, Portugal & UK). Figure 6. Country composition of the Action Group
7 4 Activities & Achievements 4.1 General Results During the period 2012-2015, the AG A2 has implemented numerous actions aligned with the Action Plan and other additional collaborative efforts such as conferences. The activities performed have resulted in a wide range of collaborative outcomes involving a number of actors with no precedent in the field of falls prevention. This was done through a continuous exchange of knowledge among a wide range of relevant players and stakeholders across EU member states and internationally. In addition, the Group is actively communicating around the topic via publications, press statements, websites and social media established by the Thematic Networks E-NO-FALLS (www.enofalls.eu/) & ProFouND (www.profound. eu.com/). A general EU fall prevention website for sharing knowledge on falls (www.fallsprevention.eu) has been also launched. 4.2 Achievements 4.2.1 Individual Commitments Several regions and reference sites have contributed to the falls prevention initiative by implementing and sharing different practices and initiatives at local or regional level. In the digital version of this State of Play you will find summaries and contact details for successful practices across Europe from this Action Group. 4.2.2 Collaborative Work This section illustrates the main achievements collaboratively obtained by the AG in each AA. Figure 7. Action Areas of the Action Group A2
8 AA1. Compilation and sharing of innovative practices AG A2 has collected and shared different innovative practices and knowledge on falls in order to be replicated, transferred and scaled up throughout Europe. Thus, a total of 40 practices on falls prevention have been collected, reflecting the variety of possible solutions for falls prevention and management. The 23 regions in which the activities related to the practices were performed covers over 76 million EU citizens. More than 3,5 million seniors are reached by activities of these practices, which cover various aspects of the integrated falls prevention and management service pathway: awareness raising, risk identification/ screening, interventions for prevention, care and cure (including rehabilitation) as well as technology and general policy measures (see figure 8 ).Also, the AG is going to deliver a study on future market perspectives aimed at analysing how the future wave of next generation falls prevention technologies will look like in 5-10 years. AA2. Data collection for Evidence Based interventions on Falls During the last three years, AG A2 has gone through the state of the art by analysing the current systems and databases enabling information sharing and data collection for stratifying and predicting the risk of falls, therefore supporting policy and decisionmaking on falls prevention at European, national and regional level. A report providing a comparative analysis of the existing fall prevention national guidelines is going to be released. AA3. Awareness Campaigns on Falls (ProFouND) Within the scope of the Prevention of Falls Network for Dissemination (ProFouND), fully aligned with the AG A2, evidence based fall prevention programmes for older people and effective training programmes have been made available in a wide range of countries/regions and are available for further scale up. Here below a brief summary of the most outstanding achievements are: Figure 8. Practices in falls prevention and management collected in AG A2 Note: some practices comprise more than one aspect.
9 1.Several commitments within AG A2 have delivered innovations in ICT solutions. These include ProFouND Falls Prevention Application among others. The app is thought to be used by healthcare practitioners and it is now available in English, German, Greek and Norwegian. 2. Over 300 best practice resources developed and sourced to guide practice development and to increase awareness about fall prevention, available in many languages. 3. Training of a large cohort of cascade trainers (100+) based in 10 EU countries, who have started training exercise instructors in some 55 regions, well in excess of our targets. 4. Establishment of a EU wide stakeholder group, the European Stakeholder Alliance for Active Ageing through Falls Prevention (ESAon Falls), which brings together 16 European level umbrella groups of professionals in health and social care, fitness and leisure, carers organisations and older people s groups who together have developed a joint declaration. 5. Falls prevention Intervention fact sheets for health care professionals which delivers best practice information on key areas including; general guidance, exercise, vision, bone health, vitamin D, home environment, footwear and protective clothing, falls detection and prevention technologies - http://profound.eu.com/profoundfactsheets-english/ 6. Annual media campaign in 12 EU member states since 2013 to include press releases, radio interviews, television news items, conference presentations (100+), and in 2015 an EU-wide Flash Mob focusing on strength and balance exercises to reduce falls - https://www.youtube.com/ watch?v=iekhwmoh084 7. Creation and delivery of the EU Falls Festival, an annual 2 day festival which celebrates the best practice approaches in falls prevention across the EU www.eufallsfest.eu AA4. Innovation, technology and market uptake of ICT solutions on falls (E-NO-FALLS) Another thematic network involved in AG A2 activities is E-NO FALLS, who along with other commitments have achieved important successes in relation to ICT solutions: 1. A showroom with 55 devices and systems (40 for falls detection & 15 for falls prevention) described in the e-no FALLS ICT repository including the reviews of technical systems as well as user-related experience and questions 2. FATE project has developed a portable Fall Detector for the Elder to be used at home and outdoor. Over 200 people involved in the testing and validation of the FATE system, developed in 3 countries, Spain, Italy and Ireland. 3. WIISEL team designed and developed an insole for the elderly, placed in the shoe, monitoring the way of walking. 54 older people were involved in the WIISEL validation trials to test the insole system developed during 2012-2015. 4. A sample of 121 elderly people were involved in the Fall Competence Centre (FCC) in Porto and 50 in the Health Week at Coimbra in order to participate in validation trials and data collection during the development of solutions for Fall Risk Assessment, Fall Detection and Fall Prevention based on smartphones. 4.3 Key messages and lessons learned Key lessons learnt so far are that a person-centered and community based infrastructure for screening and intervention is crucial to identify those who are at risk
10 and can benefit from exercise programmes, dietary support and social activities over a prolonged period of time. For seniors with a high risk for falling, multidisciplinary assessment and a multi-factorial intervention approach (exercise, medication monitoring, nutritional intervention, vitamin-d, supportive devices) showed to be most effective. Key elements of a sustainable fall prevention approach are 1) adequate financing models in which revenues (through cost savings) are included, 2) adequate implementation of the falls prevention strategy, such as sufficient resources, suitable timescales, far reaching awareness raising campaigns, 3) commitment and collaboration on all levels in the social and health domain. Implementation of integrated approaches across the health and social care whole system requires commitment of both work force and regional governance level. Often existing system barriers as financing arrangements, rules and regulations need to be transformed in order to allow piloting of innovative cost-benefit and service models. Following which the most suitable scenario can be maintained and up-scaled in to common practice. Once support and the right conditions are established and secured from a governance level, a shared vision and a change-management strategy tailored to the local context is key to make work force changes successful. It goes without saying that co-creation of the integrated service pathway with the target population and all relevant stakeholders is essential. Note: a community based approach with the inclusion of social services, the urban built environment, technology and public health is indispensable. In the thematic network E-NO-FALLS and the project I-DON T-FALL valuable experience about Pre-Commercial Procurement (PCP), business models and market opportunities for falls detection, monitoring and rehabilitation technologies (incl. ehealth) was obtained. Conclusions are that PCP can be a driver to reach the market. Because of the PCP complexity, use of experience from available successful procurements procedures is important. Health Impact Bonds have been gaining interest: the bonds pay for interventions that relevant studies demonstrated to be able to reduce fall risks and lower the cost of care. Market uptake of fall prevention IT-solutions is still in the stage of experimentation and early adoption. The high start-up costs, the lack of adequate reimbursement schemes and the limited evidence of cost-effectiveness of technologies are significant barriers in market uptake. The most important factors for uptake are the cost of deploying systems and sufficient Return On Investment (ROI). The only cross-factor relevant to all success cases is the win-win-win approach for the stakeholders involved (providers, carers, users), being also the key factor needed to achieve sufficient ROI: both in terms of health-cost savings and an increase in quality of life. Currently, the AG A2 is renovating its Action Plan for the next phase (2016-2018), according to the progress made so far and the opportunities and needs detected. Within this renovation process and building on the inputs provided by the AG members, 11 priorities have been identified so far as highly relevant for AG A2 in the coming years (figure 9 shows the score obtained by each priority in a recent survey distributed among A2 partners).
11 5 Conclusions and Future Activities Among them, the main supported objectives refer to the following issues: To optimise and multiply the scaling up of innovative practices across Europe and beyond. To work in the alignment of AG A2 objectives and outcomes with existing parallel or complementary initiatives, which derives in the generation of synergies within the EIP on AHA and beyond. To optimise the funding opportunities of the AG A2 to re-activate efforts and increase the resources invested. Synergies with other EIP on AHA action groups Together with the definition of renovated priorities, the AG A2 is working with other AGs to establish synergies and/or common objectives in EIP on AHA, as part of the Task force on synergies. Among others, a key issue identified for its cross-sectional implications is the need to develop common language and data management structures. Furthermore, it is crucial to tackle falls and fall prevention taking advantage of comprehensive and/or integrated approaches addressing also related conditions such as frailty (A3 AG). Lastly, since adequate fall prevention and management is based on integrated care principles, special attention will be paid to synergies with B3 AG on education, training, patient empowerment and self-management. The EU Falls Festival 2016 will take place on 23rd and 24th February 2016, Bologna. The theme is Implementation of Innovation into Policy and Practice, for further information see www.eufallsfest.eu. Figure 9. Relevance of the new 11 priorities for the AG A2 partners
12 6 Annexes (only for online/digital version) Annex 1 is a compilation of the relevant innovative practices on fall prevention, intervention and risk assessment collected by the AG A2 so far.