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Purpose: Current healthcare systems are not suitable for serving future societies in which the oldest old are commonplace. The objective of this study was to understand what the oldest old care most about in their daily lives. Methods: Semi-structured in-depth interviews and thematic analysis were used. Face-to-face interviews were conducted in 17 elderly residents (≥ 95 years) of Arakawa-ku, Tokyo, Japan from July to November 2017. Results: Three themes emerged from the interview responses: “unshakable beliefs and social ties,” “natural acceptance,” and “my day-to-day life with precious moments.” The oldest old strongly believe in diligence and compassion and maintain strong relationships with people around them. Despite their small social networks, they are concerned about future society. They accept their selves and their lives, including their impending deaths. Despite their functional decline, they control their lives by making very small decisions. They live on a moment-to-moment basis, cherishing simple events. Conclusion: Maintaining autonomy through making small decisions and enjoying small pleasures are important to the oldest old. Understanding the needs of the oldest old is the first step towards developing optimal geriatric care for an aging population.

Background: Due to the rise in the number of older adults within the population, healthcare demands are changing drastically, all while healthcare expenditure continues to grow. Person-centered and integrated-care models are used to support the redesigning the provision of care and support. Little is known, however, about how redesigning healthcare delivery affects the professionals involved. Objectives: To explore how district nurses and social workers experience their new professional roles as case managers within Embrace, a person-centered and integrated-care service for community-living older adults. Methods: We performed a qualitative study consisting of in-depth interviews with case managers (district nurses, n = 6; social workers, n = 5), using a topic-based interview guide. Audiotaped interviews were transcribed verbatim and analyzed using qualitative content analysis. Results: The experiences of the case managers involved four major themes: 1) the changing relationship with older adults, 2) establishing the case-manager role, 3) the case manager’s toolkit, and 4) the benefits of case management. Within these four themes, subthemes addressed the shift to a person-centered approach, building a relationship of trust, the process of case management, knowledge and experience, competencies of and requirements for case managers, and the differences in professional background. Discussion: We found that this major change in role was experienced as a learning process, one that provided opportunities for personal and professional growth. Case managers felt that they were able to make a difference, and found their new roles satisfying and challenging, although stressful at times. Ongoing training and support were found to be a prerequisite in helping to shift the focus towards person-centered and integrated care. [ABSTRACT FROM AUTHOR]

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An abstract information flow model is proposed for geriatric care, the geriatric information flow model (GIFM) by adopting an information model from cancer care and introduce characteristics for geriatric care (patient population, multidisciplinary and multi-professional approach, cross-sectoral approach). The ideal-typical geriatric patient treatment process flow is introduced. Actors (patients, physicians, therapists, organizations), information objects, and information relations as well as information flows are defined. Process flow, actors, information object, and information relations are proved with qualitative material from an accompanying study. The GIFM is validated by mapping four typical knowledge processes (multi-professional geriatric team session, interdisciplinary clinical case conferences, tumor boards, transition management) onto the model. The GIFM is stated as useful for understanding information flows and relations in geriatric care. All processes for validation can be mapped onto GIFM. In future work the GIFM should be tested with more knowledge process and could also be used for identifying gaps in the IT support of geriatric care. A study on high and low information quality in geriatric care is also proposed. [ABSTRACT FROM AUTHOR]

Estimating equations can be used when measuring the height of elderly persons is not possible. However, such methods are not always applicable; therefore, it is necessary to consider several aspects, such as sex, age, and ethnicity of the studied population to generate these equations. This study aimed to compare and validate methods of estimating the height of the Brazilian elderly nursing home residents. An accuracy study was conducted with 168 elderly persons. A total of 23 equations were quantitatively evaluated by plotting the differences in means, the Student’s t-test for paired samples, the coefficient of determination (R2), the root-mean-square error (RMSE), the interclass correlation coefficient (ICC), and by graphic analysis of the residuals. A significance value of p <0.05 was adopted. An equation was considered applicable when it had R2 >0.7, the lowest RMSE among the equations evaluated, ICC >0.7, and a confidence interval of 95%, with the smallest difference between the upper and lower limits. A greater mean height was noted among younger elderly persons and elderly men compared to up to 80 years and women elderly. Quantitative analysis revealed that equation for Puerto Ricans, using knee height and age, was the most applicable for the overall population (ICC = 0.802). The same equation was applicable for the elderly Brazilian male participants (ICC = 0.838) and for those aged 60–69 years (ICC = 0.895). None of the equations used were applicable for the height estimation of elderly women or individuals aged 70 years or more. [ABSTRACT FROM AUTHOR]

Background: India has acquired the label of ageing nation with 9% of its population being more than 60 years old. Both perceived health and chronic illness are major elements of health status in elderly and there is growing evidence that older people are at risk for manifold co-morbidities. The health problems associated with ageing are multiple and sparse data are available on health status of elderly from hospital source. Hence, this study has made an attempt to bring out hospital-based data, highlights dimensions of the health issues which helps in better understanding of disease patterns in elderly and data for policy makers. Methods: A prospective clinical profile of one hundred elderly (>60 years) patients admitted under geriatric clinic care of BLDE (DU), Shri B M Patil Medical College Hospital and Research Centre, Vijayapura over a period of twelve months is studied. The patients admitted in emergency wards are excluded. Results: Out of one hundred patients admitted, 60% were females. Majority (65%) were in age group of 60-74 years. The common symptom of presentation was breathlessness (30%). The commonest co morbid present was hypertension (21%). The final diagnosis was acute exacerbation of Chronic Obstructive Pulmonary Disease in 16%. The overall mortality was 5%. Conclusion: Elderly people are occupying more number of beds and for prolonged duration. It makes a greater demand on health services. A multidimensional and holistic approach to multi comorbidity state in elderly can be best provided by a medical college hospital at affordable cost and adequate quality, which is need of the hour. [ABSTRACT FROM AUTHOR]

Highlights • A paramedicine program gave more access to care when clinic options were limited. • Most geriatric patients did not require a higher level of care. • Of patients aged 90 and older, none required transport to a higher level of care. Abstract This study explores the use of a nurse practitioner-led paramedicine program for acute, home-based care of geriatric patients. This case series describes patients, outcomes, and geriatric primary care provider perspectives related to use of this independent paramedicine program. There were 40 patient visits from August 2016–May 2017. We reviewed patient demographics, medical conditions, healthcare utilization, and communication processes and used semi-structured interviews and content analysis to explore staff perspectives. The most commonly treated diagnoses were respiratory conditions, urinary tract infections, and gastrointestinal concerns. Two patients required an immediate transfer to a higher level of care. Six patients had emergency department visits and five patients were hospitalized within two weeks. Geriatric providers identified three themes including: potential benefits to geriatric patients, importance of enhanced care coordination and communication, and considerations for the specific role of nurse practitioner-led community paramedicine programs for geriatric patient care. [ABSTRACT FROM AUTHOR]

Objective: Home independence is an important issue for the elderly in many countries and cultures. The aim of this study was to examine the effect of short-stay service use on stay-at-home duration for elderly people by level of care need under the Japanese long-term care insurance system. Methods: We analyzed anonymous, Ministry of Health, Labour and Welfare of Japan Long-Term Care Insurance claims data from Ibaraki Prefecture. All participants were certified as eligible for long-term care insurance and had moved into a facility under long-term care insurance after certification between April 2006 and March 2012. Data was analyzed for 2,454 participants aged 65 years or older who entered residential care at least 1 month after initial use of care services. The participants were divided into 2 groups (low- and high-care need), depending on their required level of care. Cox proportional hazard modeling was used to calculate the adjusted hazard ratio (HR) of residential care admission after initial use of care services. Results: Use of short-stay services was positively correlated to delay of residential care admission compared to non-use in the low-care need group (HR; 0.834, 95% confidence interval (CI); 0.740–0.939). In the high-care need group, however, use of short-stay services was somewhat correlated with earlier admission (HR; 1.254, 95% CI; 1.084–1.451). Conclusions: The results of this study show that appropriate timing short-stay service use is necessary for the elderly to stay at home longer. [ABSTRACT FROM AUTHOR]

Objective: To describe Chinese older adults’ willingness to enter long-term care facilities and to examine individual factors associated with the willingness of using this growing model of long-term care in China. Methods: A cross-sectional study involving a random sample of 670 adults aged 60+ in the Hezuo community in Chengdu, China in 2016. Respondents were interviewed by trained staff on socio-demographics, health status, quality of life, social support, and willingness to enter long-term care facilities. Results: Only 11.9% of the respondents were willing to enter long-term care facilities for meeting their medical and social service needs. Multivariable logistic regression analysis showed that willingness to enter long-term care facilities was associated with higher household income (OR = 4.55, 95% CI:1.72–12.00), insurance of Urban Resident Basic Medical Insurance (OR = 4.80, 95% CI:1.17–19.67) and unemployment (OR = 0.48, 95% CI:0.24–0.99). Among those who were willing to enter long-term care facilities, an overwhelming majority (81.2%) would prefer going to a facility within 30-minute walking distance from their current residence, 82.5% indicated the need of nursing care, and 90.0% expected a partnership between the long-term care facility and a large hospital. Conclusions: A minority of older Chinese were willing to receive long-term care delivered at a facility within walking distance from their current residence. Recent policy aimed at increasing the supply of long-term care facilities may not be consistent with consumer preference for home and community-based care. Balancing investment between home and community-based care, and establishing long-term care insurance remain the top priorities for long-term care research and policy development in China. [ABSTRACT FROM AUTHOR]

Background: Data on nursing home admission after myocardial infarction (MI) in the elderly are scarce. We investigated nursing home admission within 6 months and 2 years after MI including predictors for nursing home admission in a nationwide cohort of elderly patients. Methods: Using Danish nationwide registries, we identified all subjects 65 years or older residing at home who were discharged following first-time MI in the period 2008–2015. We determined sex- and age-stratified incidence rates per 1000 person years (IRs) and incidence rate ratios (IRRs) of nursing home admissions using Poisson regression models compared to the Danish population 65 years or older with no prior MI. Poisson regression models were also applied to identify predictors of nursing home admission. Results: The 26,539 patients who were discharged after MI had a median age of 76 (quartile 1-quartile 3: 70–83) years. The IRs of nursing home admission after MI increased with increasing age and for 80-84-year-old women IRs after 6 months and 2 years were 113.9 and 62.9, respectively, compared to 29.4 for women of the same age with no prior MI. The IRs for 80-84-year-old men after MI were 56.0 and 36.2, respectively, compared to 24.3 for men of the same age with no prior MI. In adjusted analyses the 6 months and 2 years IRRs for 80-84-year-old subjects were 2.56 (95% CI 2.11–3.10) and 1.41 (95% CI 1.22–1.65) for women and 1.74 (95% CI 1.34–2.25) and 1.05 (95% CI 0.88–1.26) for men, respectively. Predictors were advanced age, dementia, home care, Parkinson’s disease, cerebrovascular disease, living alone, depression, and arrhythmia. Conclusion: In elderly patients discharged following first-time MI, the risk of subsequent nursing home admission within 6 months was 2-fold higher compared to an age-stratified population with no prior MI. After 2 years this risk remained higher in women. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore healthcare professionals’ personal experiences, feelings and attitudes about caring for hospitalised patients with multidrug‐resistant bacteria in palliative and geriatric care. Background: Working in end‐of‐life care involves at times burdening demands that affect not only healthcare professionals personally but also their actions. It is suggested that multidrug‐resistant bacteria and their consequences for colonised or infected patients in hospitals are among the challenges for all professionals in end‐of‐life care. Little is known about the feelings and experiences of staff members during healthcare activities with regard to these bacteria. Design: A qualitative interview study in two German hospitals. Methods: We interviewed 35 staff members from a German palliative care unit and a geriatric unit about their experiences with multidrug‐resistant bacteria in end‐of‐life care and the management of colonised or infected patients. Semistructured interviews were transcribed verbatim and analysed using grounded theory. Results: Interviewees represented two interdisciplinary teams with 40% nurses, 26% physicians and 34% other professionals. Salient themes that were identified included impact of multidrug‐resistant bacteria on staff members’ personal actions, feelings and attitudes towards the bacteria and the required isolation measures. Besides higher workload and consequences for working routines, the patients’ palliative care needs were recognised, as well as the necessary protection measures to avoid contaminations in hospital. Healthcare professionals reported a dilemma that they experienced when facing these diverse demands. Conclusions: Findings point to emotional and behavioural ambivalence in end‐of‐life care among staff members because necessary isolation measures and particular situation in end‐of‐life care create unsolvable conflicts for healthcare professionals. Possible strategies to cope with ambivalence are discussed. Relevance to clinical practice: Healthcare professionals in palliative and geriatric care have to deal with multidrug‐resistant bacteria and have to face contradictory feelings while trying to fulfil patients’ needs as well as isolation requirements. [ABSTRACT FROM AUTHOR]

Background. Klebsiella pneumoniae is a leading cause of extended-spectrum ß-lactamase (ESBL)-producing hospital-associated infections, for which elderly patients are at increased risk. Methods. We conducted a 1-year prospective cohort study, in which a third of patients admitted to 2 geriatric wards in a specialized hospital were recruited and screened for carriage of K. pneumoniae by microbiological culture. Clinical isolates were monitored via the hospital laboratory. Colonizing and clinical isolates were subjected to whole-genome sequencing and antimicrobial susceptibility testing. Results. K. pneumoniae throat carriage prevalence was 4.1%, rectal carriage 10.8%, and ESBL carriage 1.7%, and the incidence of K. pneumoniae infection was 1.2%. The isolates were diverse, and most patients were colonized or infected with a unique phylogenetic lineage, with no evidence of transmission in the wards. ESBL strains carried blaCTX-M-15 and belonged to clones associated with hospital-acquired ESBL infections in other countries (sequence type [ST] 29, ST323, and ST340). One also carried the carbapenemase blaIMP-26. Genomic and epidemiological data provided evidence that ESBL strains were acquired in the referring hospital. Nanopore sequencing also identified strain-to-strain transmission of a blaCTX-M-15 FIBK/FIIK plasmid in the referring hospital. Conclusions. The data suggest the major source of K. pneumoniae was the patient's own gut microbiome, but ESBL strains were acquired in the referring hospital. This highlights the importance of the wider hospital network to understanding K. pneumoniae risk and infection prevention. Rectal screening for ESBL organisms on admission to geriatric wards could help inform patient management and infection control in such facilities. [ABSTRACT FROM AUTHOR]

Chile is experiencing a period of rapid aging, which increases the need of long-term care services in the country. Nursing homes have been the traditional alternative to deal with the increase of elderly population in the country, with services supplied by a mix of for-profit and nonprofit providers. Additionally, population exhibits a high degree of geographical concentration. The study aims to identify the determinants of the geographical location of nursing homes in Chile at municipality level. The analysis takes into account the different location criteria for different types of nursing homes as well as potential spatial effects. The paper uses spatial analysis tools to identify clusters of nursing homes and population characteristics and to estimate the determinants of nursing homes availability and coverage in the country. The analysis–based on spatial global and local tests, and spatial autoregressive models- show the existence of clusters of nursing homes as well as clusters of municipalities according to elderly population, income, poverty, population density, and public health insurance coverage. Residuals from ordinary least squares regressions were spatially autocorrelated, showing the need of using spatial models. Estimations show that availability and coverage of nursing homes are positively related with municipality income, and that for-profit and nonprofit facilities respond differently to different factors. A negative coefficient was found for poverty in nonprofit nursing homes, raising doubts about the effectiveness of giving public subsidies to incentive the installation of facilities in areas with high needs and low income. [ABSTRACT FROM AUTHOR]

The paper addresses the question how the debate about risks and benefits of the application of medical technology should be structured. Firstly, ethical aspects of the application of medical technology in care are presented. Secondly, the discourse project Medical Technology in Nursing Homes? that is funded by the Ministry for education and research is introduced. Using methods of theme-centered active media work and campaign work such debates are initiated. An aspect that is central for the paper is how the perspective and views of persons of high age and/or with dementia can be integrated in the debate in order to give a voice to affected people in the debate. [ABSTRACT FROM AUTHOR]

Copyright of Gériatrie et Psychologie Neuropsychiatrie du Vieillissement is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: The geriatric population of the world is increasing, who very often suffers from multiple comorbidities and exposed to polypharmacy by multiple treating physicians. Aim: The study attempts to understand the challenges of pharmacotherapy in the elderly and to explore if expert oversight could address such problem optimally. Materials and Methods: A prospective, randomized, observational and interventional community based study was conducted for a year on 75 elderly subjects (>60 years) of either sex in a specific semi urban community who were randomly divided into supervised (n=40) and unsupervised (n=35) groups. The supervised group received professional counselling and guidance throughout the study period where as the other group were just routinely followed up every two months and data were collected in predesigned and validated questionnaire at each intervention. Results: Knowledge regarding medicines like the dose, frequency, duration of treatment etc., was limited across the study subjects. The impact of supervision on medication adherence was evident in the supervised group (p <0.0001). Inappropriate medication was found in almost one third of study subjects with no significant impact of professional supervision. Compliance was a very big challenge across all the elderly subjects and the most common cause for not taking medicines at regular basis was forgetfulness (41.33%) followed by inconvenience of some sort in taking medicines (13.34%) which remained unaffected by supervision. Conclusion: Communication between patient and health care provider has a significant role to play though limited for medication use and its management among the elderly subjects. Continuous monitoring by professional experts can exert a positive impact on the quality of health of the elderly population. [ABSTRACT FROM AUTHOR]

The high prevalence of urinary tract infection in aging adults is a challenging aspect of geriatric care. Incontinence and cognitive/functional impairment make collection of urine samples difficult and often require either catheterization for sample collection, which is a risk factor for infections, or more lenient criteria for initiating antibiotic treatment. We report the development of a diaper inlay with absorbent materials, superabsorbent polymer-based valve and chemical reaction pads for rapid screening of urinary tract infection of incontinent diaper-wearing elderly receivers of home care services. The developed diaper inlay was capable of collecting, isolating, analyzing samples and retaining results > 8 h. The diaper inlay can therefore be compatible with the diaper changing routines of nurses in home care services, without requiring much time or effort. A nurse can insert a diaper inlay in a diaper and the results can be recorded during a later diaper change. Although the research focuses on tools for home care services, the nursing home sector has similar problems and may benefit from technological development for rapid screening to avoid unnecessary catheterization and overuse of antibiotics. [ABSTRACT FROM AUTHOR]

Backgrounds: This study was to understand the trends of frailty research and networking features of keywords from the academic articles focusing on frailty in the last four decades. Method: Keywords were extracted from articles (n = 6,424) retrieved from Web of Science, from 1981 to April 2016, using Bibexcel, and a social network analysis was conducted using Net Miner. Results: The core-keywords of research on frailty are constantly changing over the last 40 years. The keywords were tended to focus on impact in the 1980s, and moved to the determinants (i.e., malnutrition) in the 1990s and the 2000s, and in the 2010s, most of keywords were about determinants and measurement of frailty. In the early stages of frailty research, individual behaviour modifications were emphasized as intervention. Keywords with the highest degree centralities were ‘impact’ (1980s), ‘frailty’ (1990s), ‘home care’ (2000s), and ‘dementia’ (2010s). Keywords with the highest betweenness centralities were ‘model’ (1980s), ‘frailty’ (1990s), ‘chronic disease’ (2000s), and ‘malnutrition’ (2010s). Discussion: This study provides a systematic overview of frailty knowledge development. ‘Dementia’ was found to be the keyword with the highest degree centrality, showing that studies on cognitive function are those being most actively conducted in recent decade. In the 2000s frailty research, sub-themes were sarcopenia, dementia and disability, indicating that frailty was investigated from the view of disease. In the 2010s, obesity, nutrition, prevention, evaluation, and ADL (activities of daily living) were sub-themes of the research network that focused on frailty prevention. [ABSTRACT FROM AUTHOR]

Background: Hyponatremia is the most common electrolyte disorder among hospitalized patients. Controversies still exist over the relationship between hyponatremia and outcomes of hospitalized patients. Methods: To analyze the association of low serum sodium levels at hospital admission with in-hospital mortality and patient disposition and to compare the distribution of the risk of death associated with hyponatremia across the lifespan of hospitalized patients, we conducted an observational study of 2.3 million patients using data extracted from the Cerner Health Facts database between 2000 and 2014. Logistic regression models were used in the analyses. Results: At hospital admission 14.4% of hospitalized patients had serum sodium levels [Na] <135 mEq/L. In adjusted multinomial logistic regression analysis, we found that the risk of in-hospital mortality significantly increases for [Na] levels < 135 or ≥143 to ≤145 mEq/L compared to the reference interval of 140 to <143 mEq/L (p<0.001). We observed similar trends for the relationship between [Na] levels and discharge to hospice or to a nursing facility. We demonstrated that younger age groups (18 to <45, 45 to <65) had a higher risk of in-hospital mortality compared to older age groups (65 to <75, ≥75) for [Na] levels <130 mEq/L or 143 to ≤145 mEq/L (p<0.001). Conclusions: Hyponatremia is common among hospitalized patients and is significantly associated with in-hospital mortality, discharge to hospice or to a nursing facility. The risk of death and other outcomes was more evident for [Na] <135 mEq/L. The mortality associated with low [Na] was significantly higher in younger versus older patients. [ABSTRACT FROM AUTHOR]

Background: Self-care behaviour is essential in preventing diabetes foot problems. This study aimed to evaluate the effectiveness of health education programs based on the self-efficacy theory on foot self-care behaviour for older adults with diabetes. Methods: A randomised controlled trial was conducted for 12 weeks among older adults with diabetes in elderly care facility in Peninsular Malaysia. Six elderly care facility were randomly allocated by an independent person into two groups (intervention and control). The intervention group (three elderly care facility) received a health education program on foot self-care behaviour while the control group (three elderly care facility) received standard care. Participants were assessed at baseline, and at week-4 and week-12 follow-ups. The primary outcome was foot-self-care behaviour. Foot care self-efficacy (efficacy expectation), foot care outcome expectation, knowledge of foot care and quality of life were the secondary outcomes. Data were analysed with Mixed Design Analysis of Variance using the Statistical Package for the Social Sciences version 22.0. Results: 184 respondents were recruited but only 76 met the selection criteria and were included in the analysis. Foot self-care behaviour, foot care self-efficacy (efficacy expectation), foot care outcome expectation and knowledge of foot care improved in the intervention group compared to the control group (p < 0.05). However, some of these improvements did not significantly differ compared to the control group for QoL physical symptoms and QoL psychosocial functioning (p > 0.05). Conclusion: The self-efficacy enhancing program improved foot self-care behaviour with respect to the delivered program. It is expected that in the future, the self-efficacy theory can be incorporated into diabetes education to enhance foot self-care behaviour for elderly with diabetes living in other institutional care facilities. Trial registration: Australian New Zealand Clinical Trial Registry [ABSTRACT FROM AUTHOR]

Introduction Frailty is a clinical condition characterized by enhanced vulnerability to stressors and increased risk of developing dependency and/or mortality. It has been described as the multidimensional and dynamic condition that cannot be easily disentangled from psychosocial determinants. To date, the possible role of occupational factors on frailty development and its progression at advanced age are not yet fully understood. The aim of this work is to provide a comprehensive overview of existing evidence exploring the relationship between multiple occupational issues (e.g., employment history, workplace risk factors, organizational job characteristics) and frailty. Methods A systematic search and revision of available literature addressing the contribution of occupational factors on the quantitative and qualitative aspects of frailty in the elderly was performed in the Pubmed, Scopus, and ISI Web of Science databases. Results The major weaknesses of existing literature reside in the heterogeneous operationalization of frailty and the limited description of the workplace factors. Nevertheless, an association between life-course occupational conditions and frailty was documented. In particular, intrinsically harder, manual, or blue-collar occupations emerged as possible determinants of the frailty manifestation and severity at older age. Conclusions Our preliminary results do not allow extrapolating definite conclusions. Further studies are needed. However, it seems that a significant relationship exists between the life-course occupation and frailty at advanced age. From a public health and social geriatric perspective, this work may provide the basis to define future innovations for preventing frailty at elderly adopting a life-course approach. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effects of the population-based, person-centred and integrated care service ‘Embrace’ at twelve months on three domains comprising health, wellbeing and self-management among community-living older people. Methods: Embrace supports older adults to age in place. A multidisciplinary team provides care and support, with intensity depending on the older adults’ risk profile. A randomised controlled trial was conducted in fifteen general practices in the Netherlands. Older adults (≥75 years) were included and stratified into three risk profiles: Robust, Frail and Complex care needs, and randomised to Embrace or care as usual (CAU). Outcomes were recorded in three domains. The EuroQol-5D-3L and visual analogue scale, INTERMED for the Elderly Self-Assessment, Groningen Frailty Indicator and Katz-15 were used for the domain ‘Health.’ The Groningen Well-being Indicator and two quality of life questions measured ‘Wellbeing.’ The Self-Management Ability Scale and Partners in Health scale for older adults (PIH-OA) were used for ‘Self-management.’ Primary and secondary outcome measurements differed per risk profile. Data were analysed with multilevel mixed-model techniques using intention-to-treat and complete case analyses, for the whole sample and per risk profile. Results: 1456 eligible older adults participated (49%) and were randomized to Embrace (n(T0) = 747, n(T1) = 570, mean age 80.6 years (SD 4.5), 54.2% female) and CAU (n(T0) = 709, n(T1) = 561, mean age 80.8 years (SD 4.7), 55.6% female). Embrace participants showed a greater–but clinically irrelevant–improvement in self-management (PIH-OA Knowledge subscale effect size [ES] = 0.14), and a greater–but clinically relevant–deterioration in health (ADL ES = 0.10; physical ADL ES = 0.13) compared to CAU. No differences in change in wellbeing were observed. This picture was also found in the risk profiles. Complete case analyses showed comparable results. Conclusions: This study found no clear benefits to receiving person-centred and integrated care for twelve months for the domains of health, wellbeing and self-management in community-living older adults. [ABSTRACT FROM AUTHOR]