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.

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.

Association between physical, psychological and social frailty and health-related quality of life among older people.

BACKGROUND: Studies on the association between frailty and health-related quality of life (HRQoL) are scarce and show contradictory results. This study aimed to evaluate the association between physical, psychological and social frailty and HRQoL among community-dwelling older people. METHODS: A cross-sectional study was performed with baseline data collected in 2015 from the Urban Health Centers Europe (UHCE) project in five European countries, the United Kingdom, Greece, Croatia, The Netherlands and Spain. A total of 2325 participants were included in the baseline measurements of the Urban Health Centers Europe project; 2167 participants (mean age = 79.7; SD=5.6) were included in the analyses after excluding participants with missing data. The Tilburg Frailty Indicator measured overall frailty as well as physical, psychological and social frailty. The 12-Item Short-Form Health Survey was used to measured physical and mental HRQoL. RESULTS: Regarding physical HRQoL, a large difference (d=1.29) between physically and not physically frail participants was observed. Regarding mental HRQoL, a large difference (d=1.20) between psychologically and not psychologically frail participants was observed. In the full model with all three domains of frailty and the covariates to explain physical HRQoL, physical (P <0.001) and social frailty (P <0.001) remained significant. In the full model to explain mental HRQoL, all three domains of frailty remained significant (P <0.001). CONCLUSION: Physical frailty had the strongest association with physical HRQoL, and psychological frailty had the strongest association with mental HRQoL. The associations between social frailty and both physical and mental HRQoL remain significant when controlling for physical and psychological frailty.

The effectiveness of a coordinated preventive care approach for healthy ageing (UHCE) among older persons in five European cities: A pre-post controlled trial.

BACKGROUND: Older persons often have multiple health and social problems and need a variety of health services. A coordinated preventive approach that integrates the provision of health and social care services could promote healthy ageing. Such an approach can be organised differently, depending on the availability and organizational structures in the local context. Therefore, it is important to evaluate the effectiveness of a coordinated preventive care approach in various European settings. OBJECTIVES: This study explored the effects of a coordinated preventive health and social care approach on the lifestyle, health and quality of life of community-dwelling older persons in five European cities. DESIGN: International multi-center pre-post controlled trial. SETTING: Community settings in cities in the United Kingdom, Greece, Croatia, the Netherlands and Spain. PARTICIPANTS: 1844 community-dwelling older persons (mean age = 79.5; SD = 5.6). METHODS: The Urban Health Centres Europe (UHCE) approach consisted of a preventive multidimensional health assessment and, if a person was at-risk, coordinated care-pathways targeted at fall risk, appropriate medication use, loneliness and frailty. Intervention and control sites were chosen based on their location in distinct neighbourhoods in the participating cities. Persons in the catchment area of the intervention sites 'the intervention group' received the UHCE approach and persons in catchment areas of the control sites 'the control group' received care as usual. A questionnaire and two measurements were taken at baseline and at one-year follow-up to assess healthy lifestyle, fall risk, appropriate medication use, loneliness level, frailty, level of independence, health-related quality of life and care use. To evaluate differences in outcomes between intervention group and control group for the total study population, for those who received follow-up care-pathways and for each city separately (multilevel) logistic and linear regression analyses were used. RESULTS: Persons in the intervention group had less recurrent falls (OR = 0.65, 95% CI = 0.48; 0.88) and lower frailty (B=-0.43, 95% CI= -0.65 to -0.22) at follow-up compared with persons in the control group. Physical health-related quality of life and mental well-being was better (B = 0.95; 95% CI = 0.14-1.76; and B = 1.50; 95% CI = 0.15-2.84 respectively). The effects of the UHCE approach were stronger in the subgroup of persons (53.6%) enrolled in care-pathways. CONCLUSIONS: Our study found promising but minor effects for the use of a coordinated preventive health and social care approach for the promotion of healthy ageing of older persons. Future studies should further evaluate effects of coordinated preventive health and social care aimed at healthy ageing. TRIAL REGISTRATION: ISRCTN registry number is ISRCTN52788952. Date of registration is 13/03/2017.

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.