Background Frailty is an age-related condition resulting in a state of increased vulnerability regarding functioning across multiple systems. It is a multidimensional concept referring to physical, psychological and social domains. The purpose of this study is to identify factors (demographic characteristics, lifestyle factors and health indicators) associated with overall frailty and physical, psychological and social frailty in community-dwelling older people from five European countries. Methods This cross-sectional study used baseline data from 2289 participants of the Urban Health Center European project in five European countries. Multivariable logistic regression models were used to assess associations of the factors with overall frailty and the three frailty domains. Results The mean age was 79.7 (SD = 5.7). Participants who were older, were female, had secondary or equivalent education, lived alone, not at risk of alcohol use, were less physically active, had multi-morbidity, were malnourished or with a higher level of medication risk, had higher odds of overall frailty (all P < 0.05). Age was not associated with psychological and social frailty; sex was not associated with social frailty; smoking and migration background was not associated with overall frailty or any of its domains. There existed an interaction effect between sex and household composition regarding social frailty (P < 0.0003). Conclusions The present study contributed new insights into the risk factors for frailty and its three domains (physical, psychological and social frailty). Nurses, physicians, public health professionals and policymakers should be aware of the risk factors of each type of frailty. Furthermore, examine these risk factors more comprehensively and consider overall frailty as well as its three domains in order to further contribute to decision-making more precisely on the prevention and management of frailty. Trial registration The intervention of the UHCE project was registered in the ISRCTN registry as ISRCTN52788952. The date of registration is 13/03/2017.

Background Polypharmacy can be defined as using five or more medications simultaneously. “Medication-related problems”, an extension of polypharmacy, includes inappropriate prescribing, poor adherence, overdosage, underdosage, inappropriate drug selection, inadequate monitoring, adverse drug effects, and drug interactions. Polypharmacy and the high risk of medication-related problems among older people are associated with adverse health consequences due to drug-drug interactions, drug-disease interactions, and adverse drug effects. This study aims to assess the factors associated with polypharmacy and the high risk of medication-related problems among community-dwelling older people in the Netherlands, Greece, Croatia, Spain, United Kingdom. Method This longitudinal study used baseline and follow-up data from 1791 participants of the Urban Health Center European project. Polypharmacy and the risk of medication-related problems were evaluated at baseline and follow-up using the Medication Risk Questionnaire. We studied factors in the domains (a) sociodemographic characteristics, (b) lifestyle and nutrition, and (c) health and health care use. Hierarchical logistic regression analyses were used to examine the factors associated with polypharmacy and the high risk of medication-related problems. Results Mean age was 79.6 years (SD ± 5.6 years); 60.8% were women; 45.2% had polypharmacy, and 41.8% had a high risk of medication-related problems. Women participants had lower odds of polypharmacy (OR = 0.55;95%CI:0.42–0.72) and a high risk of medication-related problems (OR = 0.50; 95%CI:0.39–0.65). Participants with a migration background (OR = 1.67;95%CI:1.08–2.59), overweight (OR = 1.37; 95%CI:1.04–1.79) and obesity (OR = 1.78;95%CI:1.26–2.51) compared to ‘normal weight’, with lower physical HRQoL (OR = 0.96, 95%CI:0.95–0.98), multi-morbidity (OR = 3.73, 95%CI:2.18–6.37), frailty (OR = 1.69, 95%CI:1.24–2.30), visited outpatient services (OR = 1.77, 95%CI: 1.09–2.88) had higher odds of polypharmacy. The associations with the high risk of medication-related problems were similar. Conclusions Multiple factors in demography, lifestyle, nutrition, and health care use are associated with polypharmacy and the high risk of medication-related problems. Polypharmacy is a single element that may reflect the number of medications taken. The broader content of medication-related problems should be considered to assess the context of medication use among older people comprehensively. These provide starting points to improve interventions to reduce polypharmacy and high risk of medication-related problems. In the meantime, health professionals can apply these insights to identify subgroups of patients at a high risk of polypharmacy and medication-related problems. Trial registration The intervention of the UHCE project was registered in the ISRCTN registry as ISRCTN52788952. The date of registration is 13/03/2017.

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Background: Polypharmacy and inappropriate medication use among older people is associated with adverse health consequences due to drug-drug interactions, drug-disease interactions, and adverse drug effects. The aim of this study is to assess the factors that are associated with polypharmacy and inappropriate medication use among community-dwelling older people in Europe.Method: This longitudinal study used baseline and follow-up data from 1791 participants of the Urban Health Center European project in five European countries. We studied factors in the domains (a) demographic characteristics, (b) lifestyle and nutrition, and (c) health and health care use, Hierarchical logistic regression models were used to examine the factors associated with polypharmacy and inappropriate medication.Results: Mean age was 79.6 years (SD±5.6 years); 60.8% were women; 45.2% had polypharmacy, and 41.8% had a high risk of inappropriate medication use. Participants who were women had higher odds of both having polypharmacy (OR=0.55;95%CI:0.42-0.72) and inappropriate medication use (OR=0.50;95%CI:0.39-0.65). Participants with a migration background (OR=1.67;95%CI:1.08-2.59), overweight (OR=1.37; 95%CI:1.04-1.79) and obesity (OR=1.78;95%CI:1.26-2.51) compared to ‘normal weight’, with lower physical HRQoL (OR=0.96, 95%CI:0.95-0.98), multi-morbidity (OR=3.73, 95%CI:2.18-6.37), frailty (OR=1.69, 95%CI:1.24-2.30), visited outpatient services (OR=1.77, 95%CI: 1.09-2.88) had higher odds of having polypharmacy. The associations with inappropriate medication use were similar.Conclusions: Multiple factors in the domains of demography, lifestyle, nutrition, and health care use are associated with polypharmacy and inappropriate medication use. These provide starting points to improve interventions to reduce polypharmacy and inappropriate medication use. In the meantime, health professionals can apply these insights to identify subgroups of patients are at a high risk of polypharmacy and inappropriate medication use. Trial registration: The intervention of the UHCE project was registered in the ISRCTN registry as ISRCTN52788952. The date of registration is 13/03/2017.