Xuxi Zhang

The first stage involved a preventive health assessment at the older person’s home or at a health centre. This was done in order to identify if there was a need or indication for follow ‐ up care ‐ pathway(s). For this purpose, a short uniform assessment formwas developed, which was to be used in all cities. The assessment consisted of instruments that had been previously validated. These instruments assessed 1) risk of falling; based on a protocol by Dutch safety research institute 27 , 2) polypharmacy; based on using five or more different medicines 28 and/or difficulty in taking medications as prescribed, 3) loneliness; based on Jong ‐ Gierveld loneliness scale 29 , and 4) frailty; based on the Tilburg Frailty Indicator 30 . The assessment was piloted in at least five older persons in each city. For the questions that were not interpreted correctly, minor changes were made. The second stage of the UHCE approach consisted of shared ‐ decision making. When the results of the assessment indicated a need for follow ‐ up care, a care plan was to be developed together with the older person, this was done to promote his/her involvement in care ‐ pathways. The UHCE template recommended discussing the results of the assessment at least between the older person, the person in charge of care coordination and the physician. Because informal caregivers can have an important role in the older person’s care, care teams were encouraged to ask the older person to involve an informal caregiver such as a partner or relative in shared ‐ decision making. The third stage of the UHCE approach consisted of referral to care ‐ pathways. After a shared ‐ decision on an individualized care plan was made, each participant was to be referred to care ‐ pathways according to their indication and preferences. The main care ‐ pathways were: 1) fall prevention actions, 2) actions addressing polypharmacy (adherence and/or appropriate prescribing actions), 3) actions addressing loneliness, and 4) frailty and other medical actions; frailty actions and other medical care which the healthcare provider deemed necessary and which did not fall under care ‐ pathways 1 ‐ 3 was given in this care ‐ pathway. The general template of the UHCE approach included evidence ‐ based interventions for each care ‐ pathway based on systematic literature searches, which were to be used by the cities. The care coordinator was asked to monitor the progress of each individual care plan under the supervision of a physician. 26 Ethical considerations Ethical committee procedures were followed in all cities, and approval was provided. Written consent was obtained from all participants. The study was registered in the ISRCTN registry under number ISRCTN52788952. Context & implementation The general template of the UHCE approach was subsequently implemented in the context of primary care and community settings in five European cities (Greater Manchester, United Kingdom; Pallini, Greece; Rijeka, Croatia; Rotterdam, the Netherlands; and Valencia, Spain). The place of assessment, type of care ‐ pathways, staff involved and context of each of the five participating cities are described in more detail in Table 1. 5 105 A coordinated preventive care approach for healthy ageing