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Frailty is one of the most challenging issues among older adults, and the relationship between frailty and falls has already been assessed numerous times in literature. In the present study, we explored the mediating role of self-efficacy related to falls (FSe) in the relationship between frailty and fall risk. In a cross-sectional design, 1080 community-dwelling older adults from Rotterdam (Netherlands) and Valencia (Spain) completed a questionnaire and data were then analyzed via mediation analysis using a bootstrapping approach. Results show that higher frailty is associated with higher fall incidence, and higher FSe is a partial mediator of this association, with a confidence interval for the indirect effect of 0.131–0.247. Moreover, results showed gender differences in FSe levels; women had lower FSe scores. Deepening research on the construct of FSe may give potential explanations that account for the emerged gender differences, and it could be more targeted in fall prevention programs. [ABSTRACT FROM AUTHOR]

Living standards capabilities are an important determinant of healthy ageing. The Living Standards Capabilities for Elders scale (LSCAPE) is the main instrument available to assess living standards capabilities among older adults based on Sen's Capability Approach. The objectives of this study were: (a) to adapt and validate LSCAPE for use in the Spanish population; (b) to examine the dimensionality, validity and reliability; and (c) to establish the convergent validity of LSCAPE using self-reported measures of quality of life and income. The LSCAPE was administered to 441 Spanish seniors aged 65 and over. Confirmatory Factor Analysis (CFA) was used to analyse the dimensionality, validity and reliability. Discriminant and convergent validity of the model were assessed using Average Variance Extracted (AVE). Reliability was shown by Composite Reliability (CR) and Cronbach's alpha. Convergent validity was tested by correlating the LSCAPE scales and sub-scales with the Short-form Health Survey (SF-12) sub-scales. CFA showed that the LSCAPE Six-factor Model fits well to the data, showing Standardised Root Mean Square Residual < 0.09 (0.084), Comparative Fit Index and Tucker–Lewis Index > 0.9 (0.925 and 0.917, respectively). LSCAPE showed also good reliability (CR indices > 0.7) and validity (AVE > 0.5) measures. Finally, LSCAPE had moderate to strong associations with SF-12 sub-scales (>0.6) and a moderate relationship with income (>0.3). Thus, LSCAPE has been demonstrated to be a reliable and valid instrument in measuring living standards capabilities among the Spanish older population. [ABSTRACT FROM AUTHOR]

This study aimed to explore and gain insight from the dialogue and subjective perception of older people about loneliness and social support using a cross-cultural approach. A total of six focus groups with 43 community-dwelling older adults were conducted in two different cultural contexts: the Spanish and the South African. Data were analysed around two key topics — loneliness and social support — using methods of thematic analysis. Findings around the topic of loneliness showed that participants from both countries agreed that loneliness was a subjective feeling and a negative experience. Besides, solitude emerged in the focus groups discussions as a pleasant and desired experience. As for social support, the lack of it was seen as the most frequent risk factor for loneliness. Differences among both countries were found on the key sources of social support. Spanish participants identified the family as the major source of social support, while among South African participants the community was presented as a main source of social support. We concluded that considering these cultural aspects and social support perceptions when developing programmes and strategies aimed at alleviating loneliness may lead to an increase in the effectiveness of these kinds of interventions, and thus to more positive outcomes. [ABSTRACT FROM AUTHOR]

Background: Knowledge transfer has been well recognised as an effective enabler to access existing evidence and learning on integrated care. It requires dedicated support to ensure that the flow of appropriate information and knowledge between adopting and transferring entities is tailored appropriately to the context and maturity of the adopting system. SCIROCCO is an online participatory tool that helps stakeholders to understand: 1) The context requirements of a particular good practice that is considered for adoption; 2) The level of maturity required for a health and social care system to adopt and scale up integrated care; 3) The actions that more progressive regions have taken to be successful and enable information sharing, twinning and coaching to overcome barriers and accelerate results in integrated care. The functionality of the tool for twinning and coaching was designed following the initial testing of the knowledge transfer activities in three regions. The design followed an iterative process involving the active participation of the SCIROCCO partners. Aims and Objectives: The objective of this workshop is to present the SCIROCCO tool and lessons learned from its application as a tool to facilitate the knowledge transfer in integrated care. We aim to present the functionalities of the tool in the context of twinning and coaching; the transferability of a good practice and/or improvement of particular dimension of integrated care. It will be an opportunity to learn about the experience of SCIROCCO regions in using SCIROCCO tool to facilitate the twinning and coaching activities. This experience was captured using focus group. We also aim to gather feedback from the workshop participants on the SCIROCCO tool and its potential impact and added value in their own regions in terms of knowledge transfer. Format: To meet these objectives, a workshop will be organised as follows: Introduction (10 min): presentation of the objectives and content by Diane Whitehouse (EHTEL). SCIROCCO tool (15 min): presentation on the tool and its development process, with a focus on the twinning and coaching activities, by Cristina Alexandru (University of Edinburgh). Analysis of users' experiences from focus groups (15 min): presentation on the users' experiences with the twinning and coaching process and perspectives on the use of the SCIROCCO tool for knowledge transfer collected though focus group, by Tamara Alhambra-Borrás (University of Valencia). Discussion and dialogue (15 min): opportunity to ask questions and discuss emerging issues with the presenters and stakeholders in the room, moderated by Diane Whitehouse. Wrap up (5 min): The main outcomes and next steps will be summarised by Diane Whitehouse. Target audience: People interested in scaling-up integrated care, self-assessment of integrated care, new tools and knowledge transfer. Learnings: Workshop participants will learn about: Development of the twinning and coaching functionality. The experience of using the SCIROCCO tool to facilitate knowledge transfer. How twinning, coaching, and the use of the tool can help with the scaling-up of Integrated Care. Ways in which the tool has been used and can be used in the future. [ABSTRACT FROM AUTHOR]

Objectives: The present mixed-method systematic review identifies facilitators and barriers in palliative care communication among health professionals and older people.Methods: The review process was conducted by three reviewers who searched studies in four different databases (January 2009-January 2022), exploring experiences of communication among health professionals and older people without cognitive impairments. Relevant articles were quality assessed with a standardized tool.Results: Twenty-eight articles were included and the following 5 clusters were identified: 1) training and education for health professionals, 2) team working and coordination among health professionals, 3) communication skills, 4) time and availability, 5) emotional, cultural and psychological factors. The articles highlighted the need for greater preparation of health professionals around the management of palliative care communication with older people.Conclusion: Palliative care communication among health professionals and older people are characterized by several challenges. However, there are facilitating aspects that may be considered to improve the quality of communication.Practice Implications: Facilitators are promising approaches to support health professionals in providing high-quality palliative care communication to older people, developing a person-centred practice. Facilitators include palliative care training and educational opportunities for health professionals, like ELNEC Geriatric Curriculum, permitting them to develop specific competences in communication and aging. [ABSTRACT FROM AUTHOR]

Frailty is a dynamic condition encompassing physical, psychological, and social domains. While certain factors are associated with overall or specific frailty domains, research on the correlations between physical, psychological, and social frailty is lacking. This study aims to investigate the associations between physical, psychological, and social frailty in European older adults. The study involved 1781 older adults from the Urban Health Centres Europe project. Baseline and 1-year follow-up data were collected on physical, psychological, and social frailty, along with covariates. Linear regression analyzed unidirectional associations, while cross-lagged panel modeling assessed bi-directional associations. Participants’ mean age was 79.57 years (SD = 5.54) and over half were female (61.0%). Physical and psychological frailty showed bi-directional association (effect of physical frailty at baseline on psychological frailty at follow-up: β = 0.14, 95%CI 0.09, 0.19; reversed direction: β = 0.05, 95%CI 0.01, 0.09). Higher physical frailty correlated with increased social frailty (β = 0.05, 95%CI 0.01, 0.68), but no association was found between social and psychological frailty. This longitudinal study found a reciprocal relationship between physical and psychological frailty in older adults. A relatively higher level of physical frailty was associated with a higher level of social frailty. There was no association between social and psychological frailty. These findings underscore the multifaceted interplay between various domains of frailty. Public health professionals should recognize the implications of these interconnections while crafting personalized prevention and care strategies. Further research is needed to confirm these findings and investigate underlying mechanisms. [ABSTRACT FROM AUTHOR]

Background: The SCIROCCO tool, developed as part of the SCIROCCO project, incorporates the Maturity Model for the adoption of Integrated Care developed by the European Innovation Partnership on Active and Healthy Ageing (B3 Action Group on Integrated Care). The online self-assessment tool can be used to facilitate scaling-up of integrated care across different health and care sectors, at different levels in health or care systems, and in a range of communities. Currently, more than 30 European regions are involved in testing the SCIROCCO tool. Since the project launch in April 2016, the tool underwent two iterations. Each of the iterations of the tool was followed by a round of refinement to inform its subsequent development so that the tool increases its usability and usefulness. Moreover, several focus group sessions were conducted to gather end-users' experiences and perspectives on the tool. Aims and Objectives: The three-fold objective of this workshop is to present the SCIROCCO tool and the learnings that have taken place around it: Use of the tool to facilitate knowledge transfer and scaling-up of integrated care. Quantitative and qualitative evaluation methodologies used for the SCIROCCO tool construction, refinement, and improvement. Future directions for the use of the tool. The workshop is also intended to gather feedback from the workshop participants on their opinions and perspectives about the SCIROCCO tool and its potential (policy) impact. Format (timing, speakers, discussion, group work, etc.): A workshop session of 90 minutes in length will be conducted. Four individual members of the SCIROCCO project will be responsible for conducting the workshop (the chair, and three people making two presentations). The session will be chaired by a SCIROCCO project leader, who will introduce the workshop. A set of presentations will follow, covering the different session objectives. First, a presentation on the tool construction and use will be given. This will be followed by a second presentation on the users' experiences and perspectives on the SCIROCCO tool collected through focus group sessions in four European regions. This second presentation will include the learnings about the future directions of the SCIROCCO tool and its policy implications. Participants will be asked to actively join in the discussion on the further enhancement of SCIROCCO tool. Target audience: This workshop targets all stakeholders interested in the scaling-up of integrated care and the development of new tools that help to understand this complex process. Learnings/Take aways: Workshop participants will learn about: The development of the SCIROCCO online self-assessment tool. The experiences in using the SCIROCCO tool to facilitate the learning and scaling-up of integrated care in more than 30 European regions. Policy impact of the SCIROCCO tool. The project itself will benefit from this workshop by: Promoting the SCIROCCO tool and sharing the insights of users of the SCIROCCO tool. Collecting feedback on the SCIROCCO tool's usability and potential policy implications. [ABSTRACT FROM AUTHOR]

Introduction: Risk of falling and frailty have been revealed as the most important conditions causing dependency among older people. Older adults taking physical activity regularly can benefit of a proper maintenance of muscle strength and mass, which helps to retain function and independence, and to prevent falls and other injuries. Concretely, the effectiveness of balance and strength training programs on the reduction of falls and frailty has been sufficiently proved. Theory/Methods: This study was conducted to evaluate the effect of an intervention based on a physical exercise program addressed at 65+ people suffering from risk of falling and frailty, and ultimately aimed at promoting active and healthy ageing. A physical exercise program composed by balance and strength training has been designed and implemented twice a week during 9 months. From a total of 60 exercises conforming the program, 34 are based on the OTAGO program, with largely proven effectiveness, and 26 have been designed in the frame of this research by a physiotherapist, who was responsible for the implementation. The 60 exercises comprise a total of ten 45-minute exercises routines of 6 exercises. An interventional longitudinal study was carried out with 55 community-dwelling older adults. Participants were assessed at baseline for frailty (Tilburg Frailty Index), risk of falling (history of falls) and physical performance (Short Physical Performance Battery). Participants were assesses with the same instruments after attending the program. Results: The comparison of the conditions (frailty and risk of falling) as well as physical performance at baseline and 9 months later was performed using paired samples t-test and McNemar's test. After the intervention, participants showed a significant reduction in frailty (p < 0.000), in risk of falling (p < 0.000) (from 65.5% to 21.8%). Furthermore, significant increases in physical performance (p < 0.007) were observed; especially, in the balance test (0.008). Discussions: The intervention program composed of balance and strength training produced a decrease in the incidence of falls, and improved the frailty levels and the physical performance in older adults who presented frailty and/or risk of falling before the intervention. It should be emphasized that the physical performance enhancements observed in the participants of the present study occurred primarily in balance, and in lesser extent in muscle strength and gait ability. This result is aligned with the research confirming balance as a key element in falls. Conclusions: (comprising key findings) The physical exercise program design and implemented in the frame of this research is an effective intervention for frailty and falls prevention among 65+ community-dwelling older adults. [ABSTRACT FROM AUTHOR]

Background: People experiencing homelessness (PEH) are known to be at higher risk of adverse health outcomes and premature mortality when compared to the housed population and often face significant barriers when attempting to access health services. This study aimed to better understand the specific health care needs of PEH and the barriers and facilitators associated with their timely and equitable access to health services in the European context. Methods: We conducted an exploratory cross-national qualitative study involving people with lived experience of homelessness and health and social care professionals in Austria, Greece, Spain, and the UK. A total of 69 semi-structured interviews comprising 15 social care professionals, 19 health care professionals, and 35 PEH were completed, transcribed, and analysed thematically. Results: Findings were organised into three overarching themes relating to the research question: (a) Health care needs of PEH, (b) Barriers to health care access, and (c) Facilitators to health care access. Overall, the general health of PEH was depicted as extremely poor, and mainstream health services were portrayed as ill-equipped to respond to the needs of this population. Adopting tailored approaches to care, especially involving trusted professionals in the delivery of care, was identified as a key strategy for overcoming existing barriers. Conclusions: The results of this study indicate there to be a high degree of consistency in the health care needs of PEH and the barriers and facilitators associated with their access to health care across the various European settings. Homelessness in itself is recognized to represent an essential social determinant of health, with PEH at risk of unequal access to health services. Changes are thus required to facilitate PEH's access to mainstream primary care. This can also be further complemented by investment in 'in-reach' services and other tailored and person-centred forms of health care. Trial registration: This study was registered retrospectively on June 6, 2022, in the registry of ClinicalTrials.gov under the number NCT05406687. [ABSTRACT FROM AUTHOR]

Background: To examine how the knowledge transfer processes unfolded within SCIROCCO, a EU funded project (3rd Health Programme (2014-2020)) that aimed to facilitate the process of knowledge sharing across five European regions, to speed up adoption and scaling-up of integrated care initiatives.Methods: A qualitative multi-method design was used. Data collection methods included focus groups, project documents and action plans of the regions. The data was analysed using a qualitative content-analysis procedure, which was guided by the frameworks of knowledge exchange and the why, whose, what, how framework for knowledge mobilisers.Results: All five components (including the themes) of knowledge exchange could be identified in the approach developed on the knowledge transfer processes. The four questions and accompanying categories of the framework of knowledge mobilisation were also identified to a large degree.Conclusions: The observed incorporation of distinct forms of knowledge from multiple sources and the observed dynamic and fluid knowledge transfer processes both suggest that SCIROCCO developed a comprehensive knowledge transfer approach aiming to enable the adoption and scaling-up of integrated care. Overall, the multi-method qualitative nature of this research has allowed some new and practical insights in the knowledge transfer activities on integrated care between several European regions. To obtain a clear understanding of the content of the knowledge transfer approaches, which could assist the operationalising of models to support the evaluation of knowledge transfer activities, it is strongly recommended that further research of this type should be conducted in other research settings. [ABSTRACT FROM AUTHOR]

Abstract 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. [ABSTRACT FROM AUTHOR]

Background: People experiencing homelessness (PEH) are known to be at higher risk of adverse health outcomes and premature mortality when compared to the housed population and often face significant barriers when attempting to access health services. This study aimed to better understand the specific health care needs of PEH and the barriers and facilitators associated with their timely and equitable access to health services in the European context. Methods: We conducted an exploratory cross-national qualitative study involving people with lived experience of homelessness and health and social care professionals in Austria, Greece, Spain, and the UK. A total of 69 semi-structured interviews comprising 15 social care professionals, 19 health care professionals, and 35 PEH were completed, transcribed, and analysed thematically. Results: Findings were organised into three overarching themes relating to the research question: (a) Health care needs of PEH, (b) Barriers to health care access, and (c) Facilitators to health care access. Overall, the general health of PEH was depicted as extremely poor, and mainstream health services were portrayed as ill-equipped to respond to the needs of this population. Adopting tailored approaches to care, especially involving trusted professionals in the delivery of care, was identified as a key strategy for overcoming existing barriers. Conclusions: The results of this study indicate there to be a high degree of consistency in the health care needs of PEH and the barriers and facilitators associated with their access to health care across the various European settings. Homelessness in itself is recognized to represent an essential social determinant of health, with PEH at risk of unequal access to health services. Changes are thus required to facilitate PEH's access to mainstream primary care. This can also be further complemented by investment in 'in-reach' services and other tailored and person-centred forms of health care. Trial registration: This study was registered retrospectively on June 6, 2022, in the registry of ClinicalTrials.gov under the number NCT05406687. [ABSTRACT FROM AUTHOR]

Introduction: Life expectancy has increased globally from 64 to 71 years. For many elderly people, hospitalization is followed by a fast decline of capacities and great mental challenges1. This progressive decline of the oldest age groups after hospitalization has triggered an increase in the prevalence of specific health and social conditions. Among these conditions, loneliness and cognitive impairment have been revealed among the most important causing dependency and re-hospitalization in elders2. In order to effectively address these issues, identifying frail elderly patients after hospitalization, and providing them with home-based care to fulfil their needs, may help to reduce readmissions at hospital facilities, and, thus, contribute to the sustainability of care systems as ultimate goal. Methodology - Intervention description: The intervention presented follows a holistic approach to hospital-at-home care, including the care of medical, social and psychological needs for elders. The intervention programme presented in this study targets older people aged 75 and above, who have been admitted at the hospital through the emergency department, and it starts after discharge from hospital to hospital-at-home. The programme is designed based on evidence, and is aimed to: 1 reduce loneliness and increase social participation; and 2 slow down the progressive cognitive impairment. As part of the intervention, the following care pathways are designed in order to complement the medical treatment and achieve the proposed aims: A motivational-based care pathway developed by social workers. This care pathway is intended to motivate the patient to take part in the community, based on patient's personal likes, being the ultimate goal to reduce loneliness. The planned structure for this care pathway is a monthly face-to-face interview and telephone follow-up, in which the patient and the social worker check the accomplishment of a set of objectives and measures they have agreed-upon. A cognitive impairment care pathway guided by psychologists. This care pathway is based on attention and memory training for those patients suffering from mild cognitive impartment. The training is delivered using a workbook including a set of exercises to train cognitive strategies. The planned structure for this care pathway is performed by a psychologist by means of a face-to-face interview and two telephone interviews per month. Conclusion: The proposed intervention programme follows a population-oriented approach focus on each patient needs. The two care pathways on which this programme is based on provide a complementary intervention to medical care, ensuring that psychological and social aspects are also covered as a part of holistic healthcare delivery. This intervention offers an innovative care strategy of integrated care for those patients receiving hospital-at-home care. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Introduction: ValueCare is an EU H2020 funded project (No 875215) which applies the principles of 'value-based care' using an integrated health and social care approach, and is supported by a robust, secure, and scalable digital solution in line with the nine pillars of Integrated Care. In the Valencia pilot (Spain), the aim is to improve the quality of life of both older people (over 65 years old) suffering from frailty, and that of their families. It also aims to improve staff satisfaction and greater efficiency in the use of resources and coordination of care. Aims Objectives Theory or Methods: From October 2020 to February 2021, the Valencia pilot researchers conducted a process of codesign to develop the integrated value-based concept and digital solution to support a personalised care pathway for frail older people. A total of 52 participants were engaged in 28 different co-design activities. All agents participating in the delivery of care were involved (older people, formal and informal caregivers, social and health care professionals, ICT experts, hospitals Managers, municipal social care services, among others). Co-design activities were adapted to the Covid-19 situation, combining in-person and virtual meetings with a reduced number of participants. All activities were recorded. Highlights or Results or Key Findings: The results of the co-design activities were analysed to define the value-based integrated care concept and requirements for the ICT solution. Regarding the value-based concept, specific outcomes for frailty were discussed with professionals. Older people's psychosocial needs are not being met under the current siloed health and social care systems, due to lack of coordination and personnel. A stronger emphasis should be placed on preventative actions and patient empowerment. An integrated social and health care system would minimise the effort and time needed to receive a more personalised and improved care plan. Regarding the ICT solution, for the older person, the solution must be intuitive, easy to manage, with minimum text and more use of images and icons, voice controlled, and friendly. For professionals, the solution must not imply a duplication of tasks and its benefits must be clear. Conclusions: An integrated intervention plan for frail older people and a supportive ICT solution have been developed based on the co-design results. Both will be tested during 12-months in a group of 120 older people (plus 120 control group). Implications for applicability/transferability sustainability and limitations: The co-design results can be used to develop other digital solutions for integrated care in other settings addressing the same target group (frail older people). Moreover, the methods applied to engage agents during the pandemic can be transferred to other researchers willing to develop codesign with the current social restrictions. [ABSTRACT FROM AUTHOR]

To assess the internal consistency, convergent and divergent validity, and concurrent validity of the Tilburg Frailty Indicator (TFI) within community-dwelling older people in Spain, Greece, Croatia, the Netherlands, and the United Kingdom. Cross-sectional study. Primary care and community settings. In total, 2250 community-dwelling older people (60.3% women; mean age = 79.7 years; standard deviation = 5.7). We assessed the reliability and validity of the full TFI as well as its physical, psychological, and social domains. Baseline data of the Urban Health Centers Europe project were used. The internal consistency was assessed with the Cronbach alpha. The convergent and divergent validity were assessed using Pearson correlation coefficients between the domains and alternative measures: the 12-item short-form, Groningen activity restriction scale, 5-item mental well-being scale of the 36-Item Short Form Survey, and the De Jong Gierveld loneliness scale. The concurrent validity was assessed by the area under the receiver operating characteristic curve with physically frail (Survey of Health, Ageing and Retirement in Europe-Frailty Instrument), loss of independence (Groningen activity restriction scale), limited function (Global Activity Limitation Index), poor mental health (5-item mental well-being scale of the 36-Item Short Form Survey), and feeling lonely (De Jong Gierveld loneliness scale) as criteria. The internal consistency of the full TFI was satisfactory with the Cronbach alpha ≥0.70 in the total population and in each country. The internal consistency of the psychological and social domains was not satisfactory. The convergent and divergent validity of the physical, psychological, and social domains was supported by all the alternative measures in the total population and in each country. The concurrent validity of the full TFI and the physical, psychological, and social domains was supported with most area under the receiver operating characteristic curve ≥0.70 in the total population and in each country. The TFI is a reliable and valid instrument to assess frailty in community-dwelling older people in Spain, Greece, Croatia, the Netherlands, and the United Kingdom. [ABSTRACT FROM AUTHOR]

Background: The Social Engagement Framework for Addressing the Chronic-disease-challenge (SEFAC) project intends to empower citizens at risk of or with type 2 diabetes (T2DM) and/or cardiovascular disease (CVD) to self-manage their chronic conditions through the SEFAC intervention. The intervention combines the concepts of mindfulness, social engagement and information and communication technology support, in order to reduce the burden of citizens with chronic conditions and to increase the sustainability of the health system in four European countries.Methods: A prospective cohort study with a 6-month pre-post design will be conducted in four European countries: Croatia, Italy, the Netherlands and the United Kingdom. A total of 360 community-dwelling citizens ≥50 years of age will be recruited; 200 citizens at risk of T2DM and/or CVD in the next 10 years (50 participants in each country) and 160 citizens with T2DM and/or CVD (40 participants in each country). Effects of the intervention in terms of self-management, healthy lifestyle behavior, social support, stress, depression, sleep and fatigue, adherence to medications and health-related quality of life will be assessed. In addition, a preliminary cost-effectiveness analysis will be performed from a societal and healthcare perspective.Discussion: The SEFAC project will further elucidate whether the SEFAC intervention is feasible and (cost-) effective among citizens at risk of and suffering from T2DM and/or CVD in different settings.Trial Registration: ISRCTN registry number is ISRCTN11248135 . Date of registration is 30/08/2018 (retrospectively registered). [ABSTRACT FROM AUTHOR]