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In their struggle to support growing numbers of community-dwelling older people with complex needs, western governments increasingly rely on ageing in place policies and engagement of the community. However, we remain relatively ignorant about the feasibility and implications of these policy imperatives. This thesis therefore sheds light on a) important neighbourhood characteristics that support ageing in place and b) the effects and processes of an integrated neighbourhood approach (INA) that aims to promote ageing in place. The findings demonstrate that both physical and social neighbourhood characteristics carry great significance for older people's well-being and ability to age in place. This study further shows that the effectiveness of integrated neighbourhood approaches may be promoted by meso- and macro-level contexts that carefully anticipate needs for innovation and collaboration at the micro-level of care and support provision. Current policy aspirations also ask for careful consideration of normative and relational aspects of integrated care and support. This thesis will be of particular interest to those researching, practicing or governing innovative ways to support community-dwelling older people.

Background: Integrated neighborhood approaches (INAs) are increasingly advocated to reinforce formal and informal community networks and support community-dwelling older people. They aim to augment older people's self-management abilities and engage informal networks before seeking professional support. INAs' effectiveness however remains unknown. We evaluated an INA's effects on older people's (health-related) quality of life (HRQoL) and well-being in Rotterdam. Methods: We used a matched quasi-experimental design comparing INA with "usual" care and support. Community-dwelling frail older (70+ years) people and frailty- and gender-matched control subjects (n = 186 each) were followed over a 1-year period (measurements at baseline and 6 and 12 months). Primary outcomes were HRQoL (EQ-5D-3L, SF-20) and well-being [social production function instrument for the level of well-being (SPF-IL)]. The effect of INA was analysed using an "intention to treat" and an "as treated" approach. Results: The results indicated that pre-intervention participants had lower incomes and were significantly older, more often single, less educated and more likely to have ≥1 disease than control subjects; they had lower well-being, physical functioning, role functioning, and mental health. Generalized linear mixed modelling of repeated measurements revealed no substantial difference in well-being or HRQoL between the intervention and control group after 1 year. The small differences we did find in the intention to treat group though were in favour of the control subjects (SF-20 = 6.98, 95 % confidence interval [CI] = 2.45-11.52; SPF-IL =.09, 95 % CI =.01-.17). However, the difference in well-being (SPF-IL) disappeared in the as treated analysis. Conclusions: The lack of effects of INA highlights the complexity of integrated care and support initiatives. Barriers associated with meeting the complex, varied needs of frail older people, and those related to dynamic political and social climates challenge initiative effectiveness. Trial registration The research was supported with a grant provided by the Netherlands Organisation for Health Research and Development (ZonMw, project number 314030201) as part of the National Care for the Elderly Programme.