Indexes, Models and <scp>IT</scp> Systems for Frailty Healthcare Process Management: An Innovative Case Study

ABSTRACT The gradual increase in the average age leads to the estimate that by 2060 about 30% of the European population will be over 65 (EU). The main issue associated with an aging population is closely linked to an increase in disease incidence resulting in higher costs for national healthcare systems. One of Europe's main challenges is the increased vulnerability of its elderly population to frailty and health problems. Frailty is certainly an age‐related condition, but it is not the only element to be considered. It is the result of the interaction between the aging process and multi‐dimensional conditions and factors related to: physical problems, psychological situation, socio‐economics, environmental factors, lifestyles, and possible chronic diseases. A variety of tools have been developed to assess frailty, and they can be applied to identify people who are at increased risk of adverse health outcomes. In this context, the aim of this paper is to analyze the frailty concept in order to identify a new approach to manage frail people and develop technological solutions to assess and monitor their health conditions. Furthermore, the paper focuses on optimizing the exchange and sharing of knowledge and clinical information professionals and between professionals and patients. The TALIsMAn project is presented as our case study, which tries to improve assistance through process reengineering and to ensure continuity of care for frail patients in an integrated ecosystem, with the support of digital health services and Business Process Management System (BPMS).