Xuxi Zhang

associations between the subdomains of frailty and HRQoL. The results show that 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 were significant when controlling for physical and psychological frailty, which was not reported by previous studies. Our results confirm the importance of considering the three domains of frailty to improve HRQoL among frail older adults. So, the study confirmed that frailty is an issue among older adults that has a negative association with both physical and mental HRQoL. Figure 9.1.1 Public Health Framework: the steps of public health approaches of studies on health promotion for frailty (Chapter 2 ‐ 5) * This is an adaptation of an original work “The public health approach. Geneva: World Health Organization (WHO); 2010. Licence: CC BY ‐ NC ‐ SA 3.0 IGO”. This adaptation was not created by WHO. WHO is not responsible for the content or accuracy of this adaptation. The original edition shall be the binding and authentic edition. The second step of the public health framework is to identify the risk and protective factors for health issues. Maintaining a healthy lifestyle in older age is suggested to be a protective factor for a lower level of frailty. 8 ‐ 11 The indicators of a healthy or unhealthy lifestyle often refer to lifestyle behaviors, such as eating habits, physical activity and sedentary behaviors, tobacco and alcohol consumption. 12 Physical activity levels tend to decline with age. 11 Older adults may experience multiple barriers for physical activity, such as specific health conditions, Chapter 2 Chapter 3 Chapter 4 and 5 Scaling ‐ up effective and promising interventions and evaluate their impact 1. Surveillance 2. Identify potential risk and protective factors 3. Develop and evaluate interventions 4. Implementation The association between frailty and health ‐ related quality of life The longitudinal association between physical activity and frailty The reliability and validity of the Tilburg Frailty Indicator (TFI) to identify frailty How does the Urban Health Centres Europe (UHCE) approach perform in terms of process components 222 Chapter 9