Xuxi Zhang

METHODS  Participants  This study was performed within the framework of the Urban Health Centres Europe (UHCE)  project. The project was funded by the European Commission Executive Agency for Health  and Consumers and aimed to promote healthy life styles, health and HRQoL of older people  in the United Kingdom, Greece, Croatia, The Netherlands and Spain. 5  The recruitment  procedure has been described in detail elsewhere 5, 17 . In short, the pre‐post controlled  intervention study measured 2325 participants at baseline and 12 months later in 2015 and  2017. Persons were invited when they were at least 70 years, lived independently and were  expected to be able to participate in the study for at least 6 months. Persons were excluded if  they lacked the basic knowledge of local language or if they were not expected to be able to  make an informed decision regarding participation in the project. Ethical committee  procedures have been followed in all cities and approval has been provided. Written informed  consent was obtained from all participants. The study was registered as ISRCTN52788952.  This study is a cross‐sectional study using baseline data from UHCE project. Supplementary  Figure S1 presents the population of the present analysis. Participants with missing data on  HRQoL (n = 127), frailty and the three domains of frailty (n = 27) and on age or sex (n = 4) were  excluded. Hence, 2167 participants were included in the analyses of this study.  Procedure  The data collection was done by means of a questionnaire. A trained researcher conducted a  face‐to‐face self‐reported semi‐structured interview at the home of the participant in United  Kingdom, Croatia, the Netherlands and Spain. In Greece, the interview was taken at  community centers and the Municipal health Center. More details could be found elsewhere. 5,  17  The interview included, among others, the 12‐Item Short‐Form Health Survey (SF‐12) 18  and  the Tilburg Frailty Indicator (TFI) 19, 20 .  Frailty   The TFI is a questionnaire based on a multidimensional approach to measure frailty and was  made and validated for use in primary care. The TFI consists of 15 self‐reported questions  covering three domains: physical (eight items, score range 0‐8), psychological (4; 0‐4) and  social frailty (3; 0‐3). 19, 20  Participants with total score of at least 5 were diagnosed as being  frail. 19  The cut points for physical, psychological and social frailty were 3, 2 and 2 respectively. 19,  21 HRQoL  The SF‐12 is a widely used patient‐reported survey for measuring general HRQoL. 18  The SF‐12  consists of 12 questions covering eight health domains, including general health, mental  health, vitality, social functioning, role limitation due to physical health problems, role  limitation due to emotional problems, bodily pain limiting usual activities, and physical  functioning. The eight domains of SF‐12 can be summarized in the Physical Component  30 Chapter 2