Running title: Effect of coordinated preventive care for healthy ageing 34 Impact statement: We certify that this work is novel. This study showed that a general 35 template for preventive integrated care aimed at healthy ageing can successfully be 36 implemented in various European settings. 37 Word count text: 4594 Word count abstract: 400 Number Tables: 4 38 Number Figures: 1 Supplements: 7 Number references: 53 39 40 2 effect paper UHCE_IJNS_revised2ABSTRACT 41 Background: Older persons often have multiple health and social problems and need a variety 42 of health services. A coordinated preventive approach that integrates the provision of health 43 and social care services could promote healthy ageing. Such an approach can be organised 44 differently, depending on the availability and organizational structures in the local context. 45 Therefore, it is important to evaluate the effectiveness of a coordinated preventive care 46 approach in various European settings. 47 Objectives: This study explored the effects of a coordinated preventive health and social care 48 approach on the lifestyle, health and quality of life of community-dwelling older persons in five 49 European cities. 50 Design: International multi-center pre-post controlled trial. 51 Setting: Community settings in cities in the United Kingdom, Greece, Croatia, the Netherlands 52 and Spain. 53 Participants: 1844 community-dwelling older persons (mean age=79.5; SD=5.6). 54 Methods: The Urban Health Centres Europe (UHCE) approach consisted of a preventive 55 multidimensional health assessment and, if a person was at-risk, coordinated care-pathways 56 targeted at fall risk, appropriate medication use, loneliness and frailty. Intervention and control 57 sites were chosen based on their location in distinct neighbourhoods in the participating cities. 58 Persons in the catchment area of the intervention sites 'the intervention group' received the 59 UHCE approach and persons in catchment areas of the control sites 'the control group' received 60 care as usual. A questionnaire and two measurements were taken at baseline and at one-year 61 3 effect paper UHCE_IJNS_revised2 follow-up to assess healthy lifestyle, fall risk, appropriate medication use, loneliness level, 62 frailty, level of independence, health-related quality of life and care use. To evaluate 63 differences in outcomes between intervention group and control group for the total study 64 population, for those who received follow-up care-pathways and for each city separately 65 (multilevel) logistic and linear regression analyses were used. 66 Results: Persons in the intervention group had less recurrent falls (OR= 0.65, 95% CI = 0.48; 67 0.88) and lower frailty (B=-0.43, 95% CI= -0.65--0.22) at follow-up compared with persons in 68 the control group. Physical health-related quality of life and mental well-being was better 69 (B=0.95; 95% CI= 0.14-1.76; and B=1.50; 95% CI=0.15-2.84 respectively). The effects of the 70 UHCE approach were stronger in the subgroup of persons (53.6%) enrolled in c...

BackgroundOlder 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.MethodsIn 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.DiscussionThe UHCE project will provide new insight into the feasibility and effectiveness of an integrated care approach for older persons in different European settings.Trial registrationISRCTN registry number is ISRCTN52788952. Date of registration is 13/03/2017.

Background: This study aimed to assess the association between loneliness and Health-Related Quality of Life (HR-QoL) among community-dwelling older citizens in five European countries. We characterize loneliness broadly from an emotional and social perspective. Methods: This cross-sectional study measured loneliness with the 6-item De Jong Gierveld Loneliness Scale and HR-QoL with the 12-Item Short-Form Health Survey. The association between loneliness and HR-QoL was examined using multivariable linear regression models. Results: Data of 2169 citizens of at least 70 years of age and living independently (mean age = 79.6 ± 5.6; 61% females) were analyzed. Among the participants, 1007 (46%) were lonely; 627 (29%) were emotionally and 575 (27%) socially lonely. Participants who were lonely experienced a lower HR-QoL than participants who were not lonely (p ≤ 0.001). Emotional loneliness [std-β: −1.39; 95%-CI: −1.88 to −0.91] and social loneliness [−0.95; −1.44 to −0.45] were both associated with a lower physical HR-QoL. Emotional loneliness [−3.73; −4.16 to −3.31] and social loneliness [−1.84; −2.27 to −1.41] were also both associated with a lower mental HR-QoL. Conclusions: We found a negative association between loneliness and HR-QoL, especially between emotional loneliness and mental HR-QoL. This finding indicates that older citizens who miss an intimate or intense emotional relationship and interventions targeting mental HR-QoL deserve more attention in policy and practice than in the past.

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.

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.