Since the 1970's, frailty emerged as a major theme and has become one of the most researched topics in aging studies. However, throughout the years, the concept ‘frailty’ became susceptible to different interpretations and has been approached by different synonyms, which resulted in a confusing picture. Based on a narrative literature review, this theoretical paper not only attempts to describe these different views on frailty, but by criticizing the dominance of some of these views, it also aspires to move the research and policy agenda on frailty forward. This paper is part of the D-SCOPE project in Belgium, and critically reflects on the blind sides of the biomedical domination of frailty and discusses three main themes: 1) frailty as a multidimensional and multilevel concept; 2) positive perspectives on frailty in later life; and 3) the suggestion of moving from a merely deficit-based frailty approach towards the concept of frailty-balance. At the theoretical level, conceptualizing frailty is not simply an exercise in semantics, but altering the theoretical definition of frailty can have wide-ranging implications, not only for the way frailty prevalence is measured and handled, but also for public or personal opinions on frailty in older people, for care and support practices, and for the scope of legislation. Therefore, the final section of the paper presents three building blocks for future research and policy-making: 1) adopting a multidimensional, multilevel, dynamic and positive view on frailty; 2) moving from dependency to interdependency; and 3) giving voice to (the resilience of) frail older people.

ABSTRACT Objective: Studies of frailty have tended to focus on adverse outcomes. This study aims to develop a short instrument that identifies a positive outcome, namely, the level of well-being in older adults at risk of frailty. Method: 871 older adults (49.4% women; mean age 75.72 years; SD = 8.05) with a frailty risk profile participated in the first wave of the D-SCOPE study. The possible domains of well-being were identified using a bottom-up approach. Exploratory Structural Equation Modeling (ESEM) and multidimensional Item Response Theory (IRT) analysis of 17 items in 4 domains measuring well-being was performed on a calibration sample ( n = 435) to develop the instrument. The instrument was subsequently corroborated by confirmatory factor analysis and convergent/divergent relations with relevant external measures in a validation sample ( n = 436). Results: The ESEM three-factor solution, with the subdimensions of sense of mastery, meaning in life, and life satisfaction, displayed good fit to the data (RMSEA = 0.070). For each dimension, the three best discriminating items were retained for the instrument following IRT analysis. Internal consistency of these dimensions was good in the validation sample (sense of mastery α = 0.864, meaning in life α = 0.715, and life satisfaction α = 0.782). The confirmatory factor analysis (CFA) three-factor model also showed good fit to the data (RMSEA = 0.064). Small to large zero-order correlations with the external measures were as expected. Conclusions: Using a bottom-up approach, this study developed a short instrument to identify levels of well-being in vulnerable or frail older adults. The instrument can be applied in primary care and prevention programs.

Universal access to healthcare has been set by the World Health Organization as a main goal for the post-2015 development agenda. Nevertheless, regarding access to care, particular attention has to be paid to so-called vulnerable groups, such as (frail) older adults. This paper aims to identify barriers frail community-dwelling older adults experience regarding access to formal care and support services. Both inductive and deductive content analysis were performed on 22 individual interviews with frail community-dwelling older adults who indicated they lacked care and support. Results indicate that (despite all policy measures) access to a broad spectrum of care and support services remains a challenge. The respondents’ barriers concern: 1) ‘affordability’ referring to the limited pensions of a lot of Belgian older adults and extensive care costs, 2) ‘accessibility’ going beyond geographical accessibility but also concerning waiting lists, 3) ‘availability’ referring to the lack of having someone around, 4) ‘adequacy’ addressing the insufficiency of motivated staff, 5) the absence of trust in care providers influencing ‘acceptability’ and 6) ‘awareness’ referring to limited health literacy. Finally, also examples of 7) ‘ageism’ within care settings were mentioned by the respondents. The discussion develops the argument that in order to make care and support more accessible for people to be able to age in place, governments should take measures to overcome these access limitations (e.g. by automatic entitlements or pro-active measures) and should take into account a broad description of access.

The Belgian Ageing Studies was developed as a participatory project involving older people to assess the age-friendliness of their community and to develop a local policy plan based on the findings of the assessment. This contribution will look back at 14 years of the Belgian Ageing Studies, and reflect on the realizations, strengths and limitations of this research-policy program. An online-survey was sent out to all communities who participated throughout the years. Results will highlight both the strengths (e.g. research for and by older people; broadened view of policy domains important for older people, establishment of a sustainable peer-research program rather than a one-time project) and limitations (e.g. difficulties in translating research results into policy action plans, difficulties in reaching migrant groups) from the research project. The paper concludes by discussing key recommendations for Belgian Ageing Studies 2.0 in order to tackle exclusion of older people in public policy.

Studies have shown that on average 11% of the older adults are frail. People with lower incomes are more likely to be frail. Research shows that early retirement leads to lower retirement income, but could also cause loss of social contacts, as the work environment is a source for social contact. The current study examines the relationship of retirement age and frailty in the later life and takes various dimensions (physical, social, psychological and environmental) of frailty into account. A cross-sectional method is used. The data are retrieved from the “Belgian Ageing Studies”, a large-scale survey (N=30 984) of community dwelling older people aged 60 and older. Frailty is operationalized by the Comprehensive Frailty Assessment Instrument (CFAI). Results are showing that retirement affects various dimensions of frailty differently. The discussion highlights the long-term effect of early retirement.

In het verlenen van “goede zorg en ondersteuning voor ouderen” is aandacht nodig voor de preventie van kwetsbaarheid bij ouderen. Een gerichte casefinding van (mogelijk) kwetsbare ouderen is hierbij essentieel om correcte preventieve maatregelen te nemen. Dit onderzoek heeft als doel om risicoprofielen en risicofactoren van kwetsbaarheid bij ouderen in kaart te brengen om zo vroegtijdige detectie mogelijk te maken. Kwetsbaarheid wordt hierbij niet enkel gezien als een fysiek probleem, maar omvat ook psychische, sociale en omgevingscomponenten. Multinomiale logistische regressie analyses op data van de Belgian Ageing Studies (N = 21.664 thuiswonende ouderen) onderzoeken de relatie van socio-demografische en socio-economische factoren op de vier domeinen van kwetsbaarheid (i. e. fysieke, psychische, sociale en omgevingskwetsbaarheid) en totale kwetsbaarheid. De resultaten tonen dat zowel mannen als vrouwen die verhuisd zijn in de afgelopen 10 jaar of een lager inkomen hebben, een groter risico hebben om kwetsbaar te zijn. Voor elk domein afzonderlijk zijn er specifieke risicofactoren gevonden (zoals burgerlijke staat bij psychische kwetsbaarheid). Daarnaast zijn er verschillen tussen risicoprofielen bij mannen en vrouwen. Zo vormt bij mannen het land van herkomst een risicofactor voor kwetsbaarheid, terwijl dit bij vrouwen niet het geval is. Op basis van de resultaten worden praktische aanbevelingen alsook toekomstige onderzoekspistes uitgewerkt voor de detectie en preventie van kwetsbaarheid bij ouderen.

This paper explores the relationships between environmental features, civic engagement and feelings of loneliness. It raises the question of how neighborhoods and municipalities promote or hinder feelings of loneliness. Data for the research are derived from the Belgian Ageing Studies, a structured survey among community-dwelling older people (n= 28 094, in 83 municipalities. We conducted multivariate regression models which included environmental factors (degree of urbanization, neighborhood connectedness and satisfaction, quantity and quality of contact with neighbors) and civic engagement (personal leisure, civic participation, informal help, community leisure, and volunteer work) on feelings of loneliness (social and emotional loneliness). The results indicate that feeling connected to the neighborhood, having qualitative contact with neighbors, and doing volunteer work or particicipate in an association lowers feelings of social loneliness. The conclusion raises practical implications and formulates a number of policy recommendations to tackle feelings of loneliness in an aging society.

Frailty in later life is mostly associated with health decline and a greater risk in adverse events. Despite their situation, these frail older adults often manage to age in place and often play an active role in their family or community. This paper focuses on the experience of frail older adults’ meaning in life and their connectedness with their social environment. 121 semi-structured qualitative interviews of older adults in Belgium were analysed. 101 Respondents (aged 60 and over) were mildly or severely frail in the physical, social, psychological or environmental domain. Findings indicate that, even severely frail older adults, experience a positive meaning in life. Key-dimensions of meaning in life were self- and moral worth, competence, purpose, connectedness, excitement and sense of coherence. The discussion highlights the various interpretations of the outcomes, while taking different frailty types and the social environment into account.

Timely detection of frailty and preventive home interventions can allow older people to age well at home. Research indicates that preventive home visits can have a preventive effect on frailty for a well-defined population. The current paper will test the effectiveness and experiences with a consecutive model of preventive home visits: step 1 visit by volunteers, step 2: visit by professionals. Quantitative and qualitative data are collected during preventive home visits performed among 450 community-dwelling older adults living in three cities in Flanders, varying in urbanisation rate (Tienen, Gent and Knokke-Heist). Results point towards the possibilities and constraints of performing preventive home visits by volunteers and develop guidelines and profiles. Second, findings demonstrate the effectiveness of the preventive home visits in terms of “detected cases who are frail but lacked care and support”. Finally, preventive home visits can guide to the most appropriate interventions, taking into account the clients’ preferences.

Prevalence data of financial elder abuse from social and health services only present a tip of the iceberg. A large number of situations are left undetected. An emerging European theme in policy and practice has been concerned with the need to focus more on early detection and prevention. This paper adopts a systematic multi-dimensional approach based on both a progressive (primary, secondary, tertiary, quaternary prevention) and ecological (micro, meso, exo, macro-level) perspective on prevention. Prevention programs for financial elder abuse are described and situated in this multi-dimensional framework. Using data from the Belgian Ageing Studies (N=7,869 people aged 60 and over), the key-argument is developed that most prevention programs are weakened by their undifferentiated treatment of various types of elder abuse. Since the results indicate that risk factors differ according to type of abuse, it is also important to differentiate by type of abuse when identifying effective prevention strategies. The presentation concludes by discussing the need to develop a particular detection and prevention strategy for financial elder abuse.

Canada.Retention strategies from our longitudinal Rural Healthy Aging study included: attention to developing and nurturing research relationships with participants and community leaders, methodological flexibility, and multiple knowledge exchange techniques.Our methodological and analytic approach highlights the importance of identifying findings that are reflective of rural seniors' experiences and that also address the program and policy responses that are necessary to support healthy aging for older adults in rural settings.The findings will be of interest to researchers in the field of community-based qualitative research and to practitioners and policy makers interested in moving research to action.