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 International studies provide an overview of socio-demographic characteristics associated with loneliness among older adults, but few studies distinguished between emotional and social loneliness. This study examined socio-demographic characteristics associated with emotional and social loneliness. Methods Data of 2251 community-dwelling older adults, included at the baseline measure of the Urban Health Centers Europe (UHCE) project, were analysed. Loneliness was measured with the 6-item De Jong-Gierveld Loneliness Scale. Multivariable logistic regression models were used to evaluate associations between age, sex, living situation, educational level, migration background, and loneliness. Results The mean age of participants was 79.7 years (SD = 5.6 years); 60.4% women. Emotional and social loneliness were reported by 29.2 and 26.7% of the participants; 13.6% experienced emotional and social loneliness simultaneously. Older age (OR: 1.16, 95% CI: 1.06–1.28), living without a partner (2.16, 95% CI: 1.73–2.70), and having a low educational level (OR: 1.82, 95% CI: 1.21–2.73), were associated with increased emotional loneliness. Women living with a partner were more prone to emotional loneliness than men living with a partner (OR: 1.78, 95% CI: 1.31–2.40). Older age (OR: 1.11, 95% CI: 1.00–1.22) and having a low educational level (OR: 1.77, 95% CI: 1.14–2.74) were associated with increased social loneliness. Men living without a partner were more prone to social loneliness than men living with a partner (OR: 1.94, 95% CI: 1.35–2.78). Conclusions Socio-demographic characteristics associated with emotional and social loneliness differed regarding sex and living situation. Researchers, policy makers, and healthcare professionals should be aware that emotional and social loneliness may affect older adults with different socio-demographic characteristics.

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 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. Design: Cross-sectional study. Setting: Primary care and community settings. Participants: In total, 2250 community-dwelling older people (60.3% women; mean age ¼ 79.7 years; standard deviation ¼ 5.7). Methods: 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 shortform, 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. Results: 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. Conclusions and Implications: The TFI is a reliable and valid instrument to assess frailty in communitydwelling older people in Spain, Greece, Croatia, the Netherlands, and the United Kingdom.