Xuxi Zhang

intervention group received care in accordance with the UHCE approach which comprised three stages: risk assessment, shared ‐ decision making and referral to care pathways aimed at reducing fall risk, inappropriate medication use, loneliness and frailty by specific interventions. 18 Further details on these interventions are described elsewhere. 17, 18 Data were obtained from self ‐ reported questionnaires at baseline and at 12 months of follow ‐ up. Ethics committee procedures were followed at all study sites and approval was obtained. 17 Written informed consent was obtained from all participants. 17, 18 The current study included participants in the UHCE project who had completed both baseline and follow ‐ up questionnaires (n = 1844). 18 Participants in whom data on PA (n = 71) and frailty (n = 38) were missing were excluded. Thus, 1735 participants were included in the analyses of the current study. Compared with the study population (n = 1735), the participants excluded from the study due to missing data on PA and frailty (n = 109) were younger (mean age = 77.1 years; SD = 6.1 years; P <. 001), had less often completed tertiary education ( P = 0.016), more often lived alone ( P < .001), and were less often at risk for alcohol use ( P = 0.045). No other significant differences between these two groups were found. Measurements Physical activity The frequency of moderate PA was measured by means of one question from the Frailty Instrument of the Survey of Health, Ageing and Retirement in Europe (SHARE ‐ FI): “How often do you engage in activities that require a low or moderate level of energy such as gardening, cleaning the car, or taking a walk?”. 19, 20 Answer categories included (a) more than once a week, (b) once a week, (c) one to three times a month and (d) hardly ever, or never. For our study, we classified these into two categories: ‘Regular frequency’ (more than once a week) and ’Low frequency’ (once a week or less). We classified the change in the frequency of moderate PA between baseline and follow ‐ up into four categories: (1) ‘Continued regular frequency’ (more than once a week), (2) ‘Decreased frequency’, (3) ‘Continued low frequency’ (once a week or less) and (4) ‘Increased frequency’. Frailty Frailty was measured with the Tilburg Frailty Indicator (TFI), which is a reliable and validated instrument to identify frailty in community ‐ dwelling older adults. 21 The TFI comprises 15 self ‐ reported questions addressing three domains: physical frailty (8 items; score range 0 ‐ 8), psychological frailty (4; 0 ‐ 4) and social frailty (3; 0 ‐ 3). An overall frailty score can be determined by adding up the 15 items (score range 0 ‐ 15), with higher scores representing a higher level of frailty. 22 54 Chapter 3