Xuxi Zhang

SUMMARY Frailty is increasingly recognized as one of the most serious public health challenges today. Frailty is a multidimensional concept with physical, psychological and social factors playing a role in its development. The Tilburg Frailty Indicator (TFI) is a multidimensional frailty measure which includes 15 items addressing 3 domains: the physical, psychological and social domains. However, many studies related to frailty focused on physical frailty only, and more studies on the psychological and social frailty are needed to provide insight regarding the determinants of, and the management of frailty. On ‐ going changes in lifestyle including diet, exercise, medication management and monitoring clinical preventive parameters have shown to be effective in better management and control of chronic conditions, such as type 2 diabetes (T2DM), as well as their complications. However, there are relatively few studies regarding the effectiveness of interventions among adults with chronic conditions to promote self ‐ management. With this thesis, we aimed to answer the following research questions: 1. What is the association between physical, psychological and social frailty and health ‐ related quality of life (HRQoL) among community ‐ dwelling older adults? (Chapter 2) 2. What are the longitudinal associations between physical activity and frailty as well as the association between a 12 ‐ month change in physical activity and frailty among community ‐ dwelling older adults? (Chapter 3) 3. What are the reliability and validity of the Tilburg Frailty Indicator (TFI) in five European countries? (Chapter 4) 4. How does the Urban Health Centres Europe (UHCE) approach perform in terms of specific process components? (Chapter 5) 5. What are the effects of peer support on glycemic control for adults with T2DM and the characteristics of effective peer support? (Chapter 6) 6. What are the effects of interventions targeting modifiable risk factors on diabetic retinopathy for adults with T2DM and the characteristics of effective interventions? (Chapter 7) 7. Could the Social Engagement Framework for Addressing the Chronic ‐ disease ‐ challenge (SEFAC) intervention be effective to promote the self ‐ management of chronic conditions and a healthy lifestyle? (Chapter 8) Chapter 2 ‐ 5 use data of UHCE project which aimed to improve the management of multi ‐ morbidity of community ‐ dwelling older people in five European countries using integrated care pathways that focus on adherence to treatment and prevention of falls and frailty. Chapter 6 ‐ 7 use data from PubMed, ScienceDirect, Web of scienceand/or Embase. Chapter 8 uses data of SEFAC project which aimed to empower citizens at risk of or with T2DM and/or cardiovascular disease (CVD) to self ‐ manage their chronic conditions through the SEFAC intervention. In Chapter 2 , the association between physical, psychological and social frailty and HRQoL was studied. The results showed that physical, psychological and social frailty each has a 10 239 Summary and samenvatting