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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.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.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.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.Although the UHCE approach was received generally positively, health constraints and psychosocial barriers prevented older person's engagement in care.Coordinated preventive care approaches for older community-dwelling persons should address health constraints and psychosocial barriers that hinder older person's engagement in care.ISRCTN registry number is ISRCTN52788952. Date of registration is 13/03/2017.目的: 评估欧洲城市保健中心(UHCE)方法具体流程组成部分;采取致力于通过减少英国、希腊、克罗地亚、荷兰和西班牙五个城市的社区中老人跌倒、多重用药、孤独和脆弱的协调预防护理方法。 设计: 对欧洲城市保健中心(UHCE)方法具体流程部分的评估:目标人群范围、实际提供和受试者接收到的干预剂量以及参与方法的主要利益相关者的满意度和体验。 方法: 欧洲城市保健中心(UHCE)方法干预包括预防评估、共享护理计划决策以及以减少跌倒、多重用药、孤独和脆弱为目标的四种协调护理方式之一或其中多个。问卷调查中的定量数据以及日志中的定量或定性数据是从参与该方法的老年人中收集而来。焦点小组的定性数据是从参与该方法的老年人、非正式护理人员以及健康专家中收集而来。采用描述性统计和多层逻辑回归模型对定量数据进行分析。采用专题分析对定性数据进行分析。 结果: 功能受限与跌倒和孤独感护理方法并未注册相关(两者均p.01)。该方法的平均评分为8.3/10(标准差(SD)为1.9)。老年人主要受益在于得到专业人员的护理以及与人见面。不信任不熟悉的护理人员以及缺乏参与护理活动的信心和健康约束是参与护理的主要障碍。 结论: 虽然欧洲城市保健中心(UHCE)方法普遍被积极接受,健康约束和心理障碍阻碍了老年人参与护理。 影响: 针对社区老年人的协调预防护理方法应解决阻碍老年人参与护理的健康约束和心理障碍。 试验注册: ISRCTN注册号是ISRCTN52788952。注册日期为2017年3月13日。.

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.

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.