Xuxi Zhang

METHODS Study Population and Data Collection The Urban Health Centers Europe (UHCE) project aimed to promote the healthy ageing of older people by implementing a coordinated preventive care approach. 20, 21 The study design has been described in detail elsewhere. 20, 21 Citizens aged 70 years or older, who lived independently and were expected to be able to participate in the project for at least 6 months were eligible. Participants were recruited in primary care and community settings in 5 European countries between May 2015 and June 2017. Data was collected with a self ‐ reported questionnaire in the local language at baseline and at 12 ‐ months follow ‐ up. Ethical committee procedures have been followed in all countries, and approval has been provided. 20, 21 Written informed consent was obtained from all participants. The study was registered as ISRCTN52788952. In the current study, we adopted a cross ‐ sectional design and used baseline data of the UHCE project (2325 participants from 5 European countries). 20 Participants with missing data on 1 or more items of the TFI (n = 75) were excluded. Thus, our analyses included 2250 participants. Measures Frailty The TFI contains 15 items addressing the physical, psychological and social domains. 12, 15, 22 The physical domain is assessed with 8 items regarding physical health, unexplained weight loss, difficulties in walking, balance, hand strength, physical tiredness, eyesight and hearing impairments. The psychological domain is assessed with 4 items regarding problems with memory, feeling down, feeling nervous or anxious and inability to cope with problems. The social domain is assessed with 3 items regarding living alone, lack of social relationships and lack of social support. Eleven items have 2 response categories: Yes and No; and 4 items have 3 response categories: Yes, Sometimes and No. 5 All items were dichotomized after recoding and scored with 0 or 1 point. 5, 19 The score range of the full TFI is 0 ‐ 15, that of the physical domain 0 ‐ 8, psychological domain 0 ‐ 4 and social domain 0 ‐ 3. 5 A detailed description of the recoding is provided in Supplementary Table S1. Previously validated versions of the TFI were available in Spanish 19 , Dutch, 12 and English. 12 Because no validated translation of the TFI was available in Greek and Croatian, all items of the TFI were translated forward and backward. 20, 21 Forward ‐  and back ‐ translations were discussed by the study team, and the translation was adapted when needed. Each language version of the TFI was piloted in at least five older people in the respective countries. Misinterpretation of questions were identified and minor changes were made. 20 The translations of the TFI in the five languages are provided in Supplementary Table S2. Other measures Health ‐ Related Quality of Life (HRQoL) was measured with the 12 ‐ item short ‐ form (SF ‐ 12) which contains 12 questions covering 8 health domains. The 8 domains are summarized in 80 Chapter 4