Interplay of Physical, Psychological, and Social Frailty among Community-Dwelling Older Adults in Five European Countries: A Longitudinal Study.

Frailty is a dynamic condition encompassing physical, psychological, and social domains. While certain factors are associated with overall or specific frailty domains, research on the correlations between physical, psychological, and social frailty is lacking. This study aims to investigate the associations between physical, psychological, and social frailty in European older adults. The study involved 1781 older adults from the Urban Health Centres Europe project. Baseline and 1-year follow-up data were collected on physical, psychological, and social frailty, along with covariates. Linear regression analyzed unidirectional associations, while cross-lagged panel modeling assessed bi-directional associations. Participants' mean age was 79.57 years (SD = 5.54) and over half were female (61.0%). Physical and psychological frailty showed bi-directional association (effect of physical frailty at baseline on psychological frailty at follow-up: ß = 0.14, 95%CI 0.09, 0.19; reversed direction: ß = 0.05, 95%CI 0.01, 0.09). Higher physical frailty correlated with increased social frailty (ß = 0.05, 95%CI 0.01, 0.68), but no association was found between social and psychological frailty. This longitudinal study found a reciprocal relationship between physical and psychological frailty in older adults. A relatively higher level of physical frailty was associated with a higher level of social frailty. There was no association between social and psychological frailty. These findings underscore the multifaceted interplay between various domains of frailty. Public health professionals should recognize the implications of these interconnections while crafting personalized prevention and care strategies. Further research is needed to confirm these findings and investigate underlying mechanisms.

A coordinated preventive care approach for healthy ageing in five European cities: A mixed methods study of process evaluation components.

AIMS: To evaluate specific process components of the Urban Health Centres Europe (UHCE) approach; a coordinated preventive care approach aimed at healthy ageing by decreasing falls, polypharmacy, loneliness and frailty among older persons in community settings of five cities in the United Kingdom, Greece, Croatia, the Netherlands and Spain. DESIGN: Mixed methods evaluation of specific process components of the UHCE approach: reach of the target population, dose of the intervention actually delivered and received by participants and satisfaction and experience of main stakeholders involved in the approach. METHODS: The UHCE approach intervention consisted of a preventive assessment, shared decision-making on a care plan and enrolment in one or more of four coordinated care-pathways that targeted falls, polypharmacy, loneliness and frailty. Quantitative data from a questionnaire and quantitative/qualitative data from logbooks were collected among older persons involved in the approach. Qualitative data from focus groups were collected among older persons, informal caregivers and professionals involved in the approach. Quantitative data were analysed by means of descriptive statistics and multilevel logistic regression models. Qualitative data were analysed through thematic analysis. RESULTS: Having limited function was associated with non-enrolment in falls and loneliness care-pathways (both p < .01). The mean rating of the approach was 8.3/10 (SD 1.9). Feeling supported by a care professional and meeting people were main benefits for older persons. Mistrust towards unfamiliar care providers, lack of confidence to engage in care activities and health constraints were main barriers towards engagement in care. CONCLUSIONS: Although the UHCE approach was received generally positively, health constraints and psychosocial barriers prevented older person's engagement in care. IMPACT: Coordinated preventive care approaches for older community-dwelling persons should address health constraints and psychosocial barriers that hinder older person's engagement in care. TRIAL REGISTRATION: ISRCTN registry number is ISRCTN52788952. Date of registration is 13/03/2017.

Factors associated with the prevalence of adolescent binge drinking in the urban areas of Greater Manchester.

Background: Binge drinking in adolescents is a serious problem that has been recognised for over a generation. On average 61% of students in the European region had consumed alcohol in the last 30 days and 43% had participated in binge drinking in the same period. This article investigates the prevalence of adolescent binge drinking and the factors associated with this prevalence in urban areas of Greater Manchester. Methods: Data were obtained from the youth survey of the European Urban Health Indicator System 2 project. Study participants were school students aged 14-16 from the urban areas of Greater Manchester. The main outcome measures were adolescent binge drinking prevalence in Greater Manchester and the socio-demographic factors influencing it. Results: Greater Manchester had an adolescent binge drinking prevalence of 49.8%. Individual factors associated with increased prevalence of binge drinking were: age, substance use, school performance and early initiation of drinking (all significant at χ2, P < 0.05). Peer factors associated with increased prevalence of binge drinking were spending evenings with friends, keeping in touch with friends, having a good relationship with peers and self-reported bullying behaviours (all significant at χ2, P < 0.05). Family support lowered the prevalence of adolescent binge drinking. Conduct problems, family affluence and perceived local crime increased the prevalence of adolescent binge drinking. Conclusions: Binge drinking is highly prevalent in Greater Manchester adolescents. Various individual, peer-related, family-related and community-related factors were associated with this problem. Any attempt to tackle the prevalence of adolescent binge drinking must take into account all of these factors.

Evaluation design of Urban Health Centres Europe (UHCE): preventive integrated health and social care for community-dwelling older persons in five European cities.

BACKGROUND: Older persons often have interacting physical and social problems and complex care needs. An integrated care approach in the local context with collaborations between community-, social-, and health-focused organisations can contribute to the promotion of independent living and quality of life. In the Urban Health Centres Europe (UHCE) project, five European cities (Greater Manchester, United Kingdom; Pallini (in Greater Athens Area), Greece; Rijeka, Croatia; Rotterdam, the Netherlands; and Valencia, Spain) develop and implement a care template that integrates health and social care and includes a preventive approach. The UHCE project includes an effect and process evaluation. METHODS: In a one-year pre-post controlled trial, in each city 250 participants aged 75+ years are recruited to receive the UHCE approach and are compared with 250 participants who receive 'care as usual'. Benefits of UHCE approach in terms of healthy life styles, fall risk, appropriate medication use, loneliness level and frailty, and in terms of level of independence and health-related quality of life and health care use are assessed. A multilevel modeling approach is used for the analyses. The process evaluation is used to provide insight into the reach of the target population, the extent to which elements of the UHCE approach are executed as planned and the satisfaction of the participants. DISCUSSION: The UHCE project will provide new insight into the feasibility and effectiveness of an integrated care approach for older persons in different European settings. TRIAL REGISTRATION: ISRCTN registry number is ISRCTN52788952 . Date of registration is 13/03/2017.

Utilizing community and voluntary sector partnerships to survey and compare the health outcomes of hard-to- reach groups to the wider community-the EURO- URHIS 2 Hard-to-Reach Project.

Background: This article describes the Hard-to-Reach (HtR) Project that was developed to capture health and lifestyle data from groups who are HtR by postal surveys within the larger EURO-URHIS 2 project. By collaborating with partner organizations, data were collected using standard survey tools, allowing for comparison with the wider population. Following a scoping exercise to determine which groups were HtR in Greater Manchester, black and minority ethnic (BME) groups and students were selected. BME groups were surveyed through partnership with Community and Voluntary Sector Organizations (CVSOs). Language barriers were addressed through the recruitment of volunteer interpreters. Students were surveyed by accessing university premises. Fifteen survey visits took place at nine CVSOs and five visits to University facilities. In total, 144 eligible surveys were collected. There were significant differences for both HtR groups, compared with Greater Manchester and the EURO-URHIS 2 mean. Both HtR groups had worse outcomes than both Greater Manchester and EURO-URHIS 2 for psychological problems. In addition, students had worse outcomes for passive smoking, binge drinking, use of cannabis, lack of access to green spaces, less sense of belonging and social cohesion and damp or mildewed homes, and better outcomes for self-perceived health and overweight and obesity. BME had in addition worse outcomes than both Greater Manchester and EURO-URHIS 2 for long-standing restrictive illness. Despite the limitations of this study, the development of this methodology allowed for the collection of comparable data, showing up statistically significant differences between the HtR populations and the wider population which merits further investigation.

The impact of a volunteer-led community cancer awareness programme on knowledge of cancer risk factors and symptoms, screening, and barriers to seeking help.

OBJECTIVE: To analyse the impact of a community cancer awareness programme on knowledge of cancer risk factors and symptoms, screening, and barriers to seeking help. METHODS: Personalised information through peer-led champions was delivered to 5500 people in a range of settings and Cancer Awareness Measures questionnaires were completed by 119 participants at pre-arranged sessions (convenience sampling) before and after the intervention. Data were analysed using McNemar tests, Mann-Whitney U test and a Wilcoxon Signed Rank test. RESULTS: Data showed increase in knowledge after the intervention for cancer screening programmes (p < 0.05), recognition of warning signs for cancer (p < 0.05), and recognition of risk factors for cancer in seven of the eleven options (p < 0.001). Results suggest a decrease in perception of barriers to seeking help (p < 0.05). The intervention had a stronger impact on recognition of cancer symptoms for people who have been affected by cancer (p = 0.02). CONCLUSION: The Cancer Awareness Measures questionnaire proved an effective tool for evaluation and awareness improved after the intervention amongst those who completed it. PRACTICE IMPLICATIONS: Enhancing the perceived personal relevance of information to those with experience of cancer may improve information processing and retention. The study highlights cancer awareness gaps among the public for future intervention development.

Longitudinal Association Between Physical Activity and Frailty Among Community-Dwelling Older Adults.

OBJECTIVES: To examine the longitudinal association between frequency of moderate physical activity (PA) and overall, physical, psychological, and social frailty among community-dwelling older adults older than 70 years. Second, we assessed the association between a 12-month change in frequency of moderate PA and frailty. DESIGN: Longitudinal cohort study. SETTING: Community settings in Spain, Greece, Croatia, the Netherlands, and the United Kingdom. PARTICIPANTS: A total of 1735 participants (61.1% female; mean age = 79.6 years; SD = 5.5 years). MEASUREMENTS: The frequency of self-reported moderate PA was measured and classified into two categories: "regular frequency" and "low frequency." The 12-month change in frequency of moderate PA between baseline and follow-up was classified into four categories: "continued regular frequency," "decreased frequency," "continued low frequency," and "increased frequency." The 15-item Tilburg Frailty Indicator assessed overall, physical, psychological, and social frailty. RESULTS: Participants who undertook moderate PA with a regular frequency at baseline were less frail at 12-month follow-up than participants with a low frequency. Participants who undertook moderate PA with a continued regular frequency were least frail at baseline and at 12-month follow-up. After controlling for baseline frailty and covariates, compared with participants with a continued regular frequency, participants with a decreased frequency were significantly more overall (B = 1.31; 95% confidence interval [CI] = 0.99-1.63), physically (B = 0.80; 95% CI = 0.58-1.03), psychologically (B = 0.43; 95% CI = 0.30-0.56), and socially frail (B = 0.14; 95% CI = 0.04-0.23) at 12-month follow-up; participants with a continued low frequency were significantly more overall (B = 1.16; 95% CI = 0.84-1.49), physically (B = 0.73; 95% CI = 0.51-0.96), psychologically (B = 0.42; 95% CI = 0.29-0.55), and socially frail (B = 0.13; 95% CI = 0.04-0.23) at 12-month follow-up; the 12-month follow-up frailty level of participants who undertook moderate PA with an increased frequency was similar to those with a continued regular frequency. CONCLUSION: Maintaining a regular frequency of PA as well as increasing to a regular frequency of PA are associated with maintaining or improving overall, physical, psychological, and social frailty among European community-dwelling older adults older than 70 years. J Am Geriatr Soc 68:1484-1493, 2020.