'Normality in all the abnormality'-Older adults' experiences of holidays and celebrations from the COVID-19 pandemic.

INTRODUCTION: The importance of holidays, traditions, and family celebrations to human culture and occupational engagement has been neglected. The aim of this study was to explore how older adults experienced holidays and celebrations with social and physical distancing during the COVID-19 pandemic. METHODS: A secondary analysis was made on data from the At-Risk Study. Seventeen community-living adults (11 women and 6 men) aged 71-87 years, from Sweden participated. They were interviewed remotely four times during the first year of the pandemic. Data were analysed with qualitative content analysis. No consumer/community involvement occurred. FINDINGS: Three categories on how the participants hoped for, planned, decided, adapted, avoided, and experienced holidays and celebrations with social and physical distancing included expectations and preparations in unpredictable times; the constant need for re-evaluation; and almost everything turned out differently. CONCLUSIONS: The desire to celebrate despite pandemic restrictions shows the importance and meaning holidays hold for older adults. Celebrations can be disrupted for many reasons, not only as extreme as the ongoing pandemic. For wellbeing in later life health care, social care, and society need to understand the inherent components and acknowledge ways of supporting participation in occasional events such as holidays, traditions, and family celebrations.

Translation and Psychometric Evaluation of the University of Jyvaskyla Active Aging Scale (UJACAS) for Use in Sweden.

The objectives were to translate the University of Jyvaskyla Active Aging Scale (UJACAS) to Swedish, to establish semantic equivalence and evaluate psychometric properties for use among persons 55 years and older in Sweden. The UJACAS contains 17 items to be self-assessed regarding goals, abilities, opportunity, and activity. Psychometric properties content validity, data quality including floor and ceiling effects, test-retest reliability, internal consistency, and construct validity were evaluated with different samples in three phases, using state-of-the-art statistics. After translating and establishing semantic equivalence, content validity was assessed as high. With ICC = 0.88 (95% CI 0.80-0.93) test-retest reliability was moderate. Internal consistency was high (Cronbach alpha = 0.84-0.91), and 84% of the questions reached the cut-off value of 0.3 for corrected item-total correlation. Construct validity hypotheses were confirmed. Results indicate that the UJACAS is reliable and valid for use among persons 55 and older in Sweden.

Ageing in the right place-usability of a web-based housing counselling service.

INTRODUCTION: Residential reasoning is a complex process that includes decisions on whether to age in place or to relocate. Ageing in the Right Place (ARP), a web-based housing counselling service was created to support older adults in this process. The study's aim was to evaluate the usability of the ARP as regards content, design, specific functions, and self-administration as a mode of delivery and to lay the ground for further optimisation. MATERIAL AND METHOD: Nine women and five men (aged 66-82) completed a series of tasks using the ARP. Qualitative and quantitative usability data were collected through online interviews. Data were analysed using qualitative content analysis and descriptive statistics. RESULTS: Experiences of the specific functions, content, and design of the ARP were described as mainly positive. Additions to the content and optimisation to assist in the general navigation of the website were suggested. The participants disagreed regarding the preferred mode of delivery, which indicates a need for selectable options. A system usability scale median score of 84 indicated acceptable usability. CONCLUSION: The ARP seems to have acceptable usability, which paves the way for further evaluation. SIGNIFICANCE: By enabling residential reasoning, older adults are supported to make proactive choices based on informed decisions.

Synthesizing implications of a collaborative project on socially sustainable housing policies for the aging population.

OBJECTIVE: Based on findings from four transdisciplinary original research studies on housing issues for the aging population, whereof three had a particular focus on marginalized groups, we report a co-produced synthesis of implications from a collaborative research project on socially sustainable housing policies. Researchers and non-academic partners in the ongoing Thematic Collaboration Initiative Social Rights and Housing for the Aging Population at Lund University collaborated in co-creative activities aiming at policy recommendations. RESULTS: Seven types of implications (i.e., themes) that represent macro and meso level approaches with potential to generate impact on social rights and housing for the aging population were identified. The content of legislation and regulations, financial institution strategies, and housing and neighbourhood development exemplify macro level implications. The three themes education and training, communicating with a diversity of stakeholders, and communicating with the public all relate to an overall need for integrated knowledge translation. The theme involving older adults as a resource delivered insight into underutilized capacities of the diverse target group. As the quest for integrated knowledge translation is growing stronger, this research note contributes to development of co-production approaches to synthesize implications of transdisciplinary collaboration, connecting research, practice and policy on societal challenges that ay population aging.

Support Needs Among Older Tenants Living in Public Housing in Sweden: Perspectives of Janitors and Maintenance Staff.

Neighborhood support can improve aging in place for older adults, but research on the role of public housing staff in supporting older tenants is lacking. Twenty-nine participants (janitors, n = 11; maintenance staff, n = 18) collected data about critical situations among older tenants residing in apartments in Sweden. Modifying the Critical Incident Technique (CIT) and applying a mixed-methods design, quantitative and qualitative data were collected and analyzed with descriptive statistics and thematic analysis, integrated through narrative. We found that older tenants asked staff for help with daily tasks. The staff identified CI management dilemmas in meeting older tenants' support needs while following the housing company's regulations, maintaining professional responsibilities, respecting individual work attitudes and preferences, and experienced a lack of competencies in some situations. Staff members were responsive to offering support in simple, practical, and emotional situations and in addressing matters they perceived as deficits in social and health services.

Crime, Disorder, and Territorial Stigmatization: Older Adults Living in Deprived Neighborhoods.

BACKGROUND AND OBJECTIVES: The existence of social problems, crime, and a diminishing sense of community are acknowledged challenges to residents of deprived neighborhoods. In research on deprived neighborhoods in Sweden, the perspectives of young residents and adults of working age dominate. This study explores how older adults in deprived neighborhoods in Sweden experience crime and disorder, and how they adapt and respond to these problems and the neighborhood's poor reputation. RESEARCH DESIGN AND METHODS: Semistructured interviews were conducted with 22 older adults who had lived 5 years or more in deprived areas of two cities in Sweden. Data were analyzed using Hirschman's theory of exit, voice, and loyalty with a thematic analysis. RESULTS: Most residents had positive things to say about their homes and neighborhoods, even if criminal acts such as shootings, drug dealing, arson, burglary, and knife attacks were part of everyday life. The residents attempted to manage these events with various strategies. Exit strategies included relocation and forms of adaptation and detachment. They used several voice strategies to actively try to solve the problems and engage with the community. Loyalty strategies-and relativizing-were used to defend their neighborhood reputation. DISCUSSION AND IMPLICATIONS: The findings show we should move on from generalized notions of older adults as passive victims of their environment and highlight that some older adults are active agents in building communities in deprived neighborhoods. City improvement programs should extend support to older adults who wish to engage. Approaches are identified which may strengthen older adults' contributions in such neighborhoods.

Older Adults Living in Disadvantaged Areas: Protocol for a Mixed Methods Baseline Study on Homes, Quality of Life, and Participation in Transitioning Neighborhoods.

BACKGROUND: Swedish policy states that older adults should be able to age safely with continued independence and lead active lives. However, this plays out differently in different Swedish municipalities depending upon degree of demographic change, globalization, and urbanization. Internationally, older adults living in disadvantaged areas have worse physical and mental health, activity restrictions, and reduced life expectancy. In Sweden, research on how disadvantaged areas impact older adults' quality of life is virtually nonexistent. We argue that disadvantaged areas exist in both urban and rural contexts. OBJECTIVE: We aimed to investigate how older adults' homes and neighborhoods influence their community participation, quality of life, identity, and belonging in urban and rural disadvantaged areas in Sweden, and how these person-context dynamics are experienced by older adults in transitioning neighborhoods. METHODS: The study has a mixed methods design and includes 3 phases. Adults 65 years and older living in certain urban and rural disadvantaged areas in the south of Sweden will be included. Phase 1 is an interview study in which qualitative data are collected on neighborhood attachment, identity, and belonging through semistructured interviews and photo-elicitation interviews with 40 subjects. A variety of qualitative data analysis procedures are used. In phase 2, a survey study will be conducted to explore associations between observable and self-rated aspects of housing and neighborhood (physical, social, and emotional), participation, and quality of life; 400 subjects will be recruited and added to the 40 phase-1 subjects for a total of 440. The survey will include standardized measures and study-specific questions. Survey data will be analyzed with mainstream statistical analyses and structural equation modeling to understand the interactions between quality of life, home and neighborhood factors, and sociodemographic factors. In phase 3, the integration study, survey data from the 40 participants who participated in both data collections will be analyzed together with qualitative data with a mixed methods analysis approach. RESULTS: As of the submission of this protocol (August 2022), recruitment for the interview study is complete (N=39), and 267 participants have been recruited and have completed data collection in the survey study. We expect recruitment and data collection to be finalized by December 2022. CONCLUSIONS: With an increasing proportion of older adults, an increasing number of disadvantaged areas, and an increasing dependency ratio in more than 50% of Swedish municipalities, these municipalities are transforming and becoming increasingly segregated. This study will add unique knowledge on what it is like to be older in a disadvantaged area and deepen knowledge on housing and health dynamics in later life. Further, the design of the current study will allow future follow-up studies to facilitate longitudinal analysis (if funding is granted) on aging in a transforming societal context. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/41255.

Where to Retire? Experiences of Older African Immigrants in the United States.

Doubling in size since the 1970s, the aging needs of the African immigrant population are not fully understood. This qualitative study examined experiences of aging and retirement planning for African immigrant older adults in the United States (U.S.). Specifically, it explored the factors, processes, and ultimate decision of where these older adults planned to retire. Secondary analysis of semi-structured interviews with 15 older African immigrants in the Baltimore-Washington Metropolitan area was conducted. Data was analyzed using thematic analyses in NVivo. The majority of participants were women, with a mean age of 64. Three overarching themes with ten sub-themes were identified. The themes included: (1) cultural identity, which indicated the participant's comfort with the U.S. society and culture; (2) decision making, meaning factors that impact participants' choice of retirement location; and (3) decision made, meaning the final choice of where participants would like to retire. Age-friendliness for immigrant older adults in the U.S. is complex and it includes traditional domains such as physical and sociocultural environment (e.g., housing, transportation, and income). However, immigrant age-friendliness also needs to include wider contextual aspects such as political climate of their country of origin, immigrant status, family responsibilities, and acculturation in the U.S. More research is needed to better understand and facilitate age-friendly environments and transnational aging of immigrant older adults.

Changes in daily life and wellbeing in adults, 70 years and older, in the beginning of the COVID-19 pandemic.

BACKGROUND: In the beginning of the COVID-19 pandemic, Swedish authorities enforced specific recommendations on social distancing for adults 70 years and older (70+). Day-to-day life changed for 15% of the Swedish population. The aim of the study was to explore how adults 70+ experienced and managed changes in everyday life due to the COVID-19 pandemic and how those changes affected wellbeing at the beginning of the virus outbreak. METHODS: Eleven women and six men, (mean age 76 years), living in ordinary housing, participated in remote semi-structured interviews in April 2020. The interviews were analysed with qualitative content analysis. FINDINGS: The theme Suddenly at risk - '…but it could have been worse' included four categories My world closed down; Negotiations, adaptations and prioritizations to manage staying at home; Barriers and facilitators to sustain occupational participation; and Considerations of my own and other's health and wellbeing emerged from the data analysis. CONCLUSION: Everyday life changes had implications for health and well-being. The participants questioned previous conceptions of meaning in relation to habitual activities, likely leading to consistent occupational changes. However, these long-term effects remain to be explored, and considered to enable older adult's health during the pandemic and beyond.

Exploring Associations of Housing, Relocation, and Active and Healthy Aging in Sweden: Protocol for a Prospective Longitudinal Mixed Methods Study.

BACKGROUND: While housing and neighborhood features have the potential to impact opportunities for active aging, there is a lack of knowledge related to how older people reason regarding their housing situation and how housing and fulfillment of relocation are associated with active and healthy aging. OBJECTIVE: The objectives of Prospective RELOC-AGE are to study housing choices and relocation and explore effects on active and healthy aging among men and women aged 55 years and older in Sweden considering relocation. METHODS: The estimated sample (2800) will include people aged 55 years and older being listed for relocation at either of two housing companies: a local public housing company in Southern Sweden and a national condominium provider. Prospective RELOC-AGE has a 2-level longitudinal mixed methods design and includes quantitative surveys (implemented by a professional survey company) and a telephone interview for baseline data collection in 2021, with follow-ups with the same procedures in 2022 and 2023. The survey and interviews include questions related to present housing and neighborhood, relocation plans and expectations, a range of perspectives on active and healthy aging, and demographics. Linking to national registers will provide additional data on home help and health care use, objective housing, and neighborhood characteristics. To explore what housing attributes older adults considering relocation find important and to what extent when making their decisions on housing, we will develop a discrete choice experiment to be implemented with a subsample of participants. Further, a grounded theory approach will be applied to collect in-depth interview data from participants who have moved to another dwelling, within 6 months of the move. A follow-up interview 12 months later will focus on participants' deepened experience over time in terms of fulfilled expectations and relocation experiences. RESULTS: As of submission of this protocol (June 2021), recruitment has commenced with approximately 960 respondents to the survey and ongoing telephone interviews. We anticipate recruitment and data collection based on surveys and interviews to continue during 2021. CONCLUSIONS: Prospective RELOC-AGE has the capacity to generate new policy-relevant knowledge on associations of housing, relocation, and active and healthy aging. Such knowledge is relevant for the development of proactive approaches to housing in old age on the individual, group, and societal levels. TRIAL REGISTRATION: ClinicalTrials.gov NCT04765696; https://clinicaltrials.gov/ct2/show/NCT04765696. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/31137.

Community-dwelling older adults who are low-income and disabled weathering financial challenges.

Despite interventions aiming to improve outcomes among older adults experiencing financial challenges, the challenges and strategies employed to handle them are poorly understood. This study examined the experiences of financial challenges among low-income adults aged ≥65 years. Eleven semi-structured interviews were analyzed using thematic analyses. An overarching theme was "I guess it balances", capturing attempts to maintain hope and proactively address challenges despite stress, uncertainty and limitations. Balancing was demonstrated within four domains, including cognitive bandwidth ("think a lot" versus "I don't dwell on that"), emotional experience ("depressing" versus "be thankful"), learned resilience ("that was a shock" versus "there's always a way"), and meeting daily needs ("we learned to do without" versus "take a dollar and stretch it"). Participants described being weathered by challenges and using predominately high-effort coping strategies to weather the challenges. These findings call for strengthening the safety net for older adults facing financial challenges.

The Psychometric Properties of the Meaning of Home and Housing-Related Control Beliefs Scales among 67-70 Year-Olds in Sweden.

BACKGROUND: The housing environment is important for health and well-being among older people, and it is important to consider both physical and perceived aspects of housing. Psychometrically sound scales are necessary to assess perceived housing. This study evaluated the psychometric properties of two instruments that measure perceived aspects of housing among a younger cohort of older adults in Sweden. METHODS: A random sample of 371 participants aged 67 to 70 years (mean 67.9 (SD = 0.98)) was used. Participants lived in ordinary housing in the south of Sweden. Data on perceived aspects of housing were collected with the Meaning of Home Questionnaire (MOH) and the Housing-Related Control Beliefs Questionnaire (HCQ). Internal consistency, corrected item-total correlations, floor and ceiling effects, and construct validity were analyzed. RESULTS: Cronbach's alphas for all four subscales of MOH and two of three subscales of HCQ had acceptable levels (α > 0.50). Some items from both scales had low item-total correlations. All subscales, except for one from HCQ, had good construct validity. CONCLUSION: While both instruments had some limitations, all subscales with one exception had adequate psychometric properties. When used in different national contexts, further development may be necessary to achieve conceptual equivalence.

"So I am Stuck, but it´s OK": Residential Reasoning and Housing Decision-Making of Low-Income Older Adults with Disabilities in Baltimore, Maryland.

Housing preferences and housing decision-making in later life are critical aspects of aging in place, which is a public health priority in many Western countries. However, few studies have examined the economic, social, and health factors that guide older adults' preferences and decisions about where to live, and even less so among older adults with low income or disabilities who may face greater barriers to aging in place. We sought to understand what housing decision-making and residential reasoning means for low-income older adult homeowners in Baltimore, Maryland. Using a grounded theory approach, we interviewed 12 adults with disabilities in June 2017 and February 2018. Our findings revealed how the strong desire to age in place turned into the realization that they had to age in place due to limited resources and options. The core category "shifting between wanting to age in place and having to age in place" was influenced by family needs, being a homeowner, the neighborhood, and coping at home. In conclusion, for low-income older adults with disabilities, it is important to acknowledge that sometimes aging in place may be equivalent to being stuck in place.

Pilot Outcomes of a Multicomponent Fall Risk Program Integrated Into Daily Lives of Community-Dwelling Older Adults.

Objectives: To evaluate whether a fall prevention intervention reduces fall risk in older adults who have previously fallen. Design: Randomized controlled pilot trial. Setting: Participants' homes. Intervention: LIVE-LiFE, adapted from Lifestyle-Intervention Functional Exercise (LiFE) integrates strength and balance training into daily habits in eight visits over 12 weeks. The adaptations to LiFE were to also provide (a) US$500 in home safety changes, (b) vision contrast screening and referral, and (c) medication recommendations. Control condition consisted of fall prevention materials and individualized fall risk summary. Measurement: Timed Up and Go (TUG) and Tandem stand. Falls efficacy, feasibility, and acceptability of the intervention. Results: Sample (N = 37) was 65% female, 65% White, and average 77 years. Compared with the control group, each outcome improved in the intervention. The LIVE-LiFE intervention had a large effect (1.1) for tandem stand, moderate (0.5) in falls efficacy, and small (0.1) in the TUG. Conclusion: Simultaneously addressing preventable fall risk factors is feasible.

Ageing in the right place - a prototype of a web-based housing counselling intervention for later life.

Background: Despite a strong desire among most older adults to age in place, there are few widely available services to support planning and preparing for one's future housing needs.Objective: To develop a prototype of a web-based housing counselling intervention for use in later life, by employing a user-centred design.Material and Methods: As the first step in intervention development, we employed a development process based on research circle methodology. Nine older adults participated in three sessions. Findings from literature reviews, a meeting with a technology and design panel (n = 6) and interviews with representatives of nonprofit organizations, companies, and municipalities (n = 7) served as discussion points.Result: An on-paper prototype was derived, composed of the THINK, LEARN and ACT module reflecting different stages of the decision-making process. Each module addressed preferences, health, home and social and financial resources. Key design features and theoretical underpinnings were included.Conclusion and Significance: A user-centred design process can result in services that are aligned with older adults' preferences for obtaining housing information. Services for planning and preparing future housing needs have the potential to increase older adults´ well-being at home as well as reduce costs for care and housing provision by the municipalities.

Attention control group activities and perceived benefit in a trial of a behavioral intervention for older adults.

Researchers trialing behavioral interventions often use attention control groups, but few publish details on attention control activities or perceived benefit. Attention control groups receive the same dose of interpersonal interaction as intervention participants but no other elements of the intervention, to control for the benefits of attention that may come from behavioral interventions. Because intervention success is analyzed compared to control conditions, it is useful to examine attention control content and outcomes. The purpose of this study is to report on attention control visit activities and their perceived benefit in a randomized control trial. The trial tested an aging-in-place intervention comprised of a series of participant goal-directed visits facilitated by an occupational therapist, nurse, and handyman. The attention control group participants received visits from a lay person. We report on the number and length of visits received, types of visit activities that participants chose, and how much visit time was spent on each activity, based on the attention visitor's records. We report on participant perceptions of benefit based on a 10-item Likert-scale survey. The attention control group participants (n = 148) were cognitively intact, at least 65 years old, with at least one Instrumental Activities of Daily Living. Attention control group participants most often chose conversation (20.1% of visit time), and playing games (18.7%), as visit activities. The majority of attention control group participants (63.4%) reported "a great deal" of perceived benefit. Attention control group visits may be an appropriate comparison in studies of behavioral interventions for community-dwelling older adults.

Preventing falls among older fallers: study protocol for a two-phase pilot study of the multicomponent LIVE LiFE program.

BACKGROUND: Falls reflect sentinel events in older adults, with significant negative consequences. Although fall risk factors have been identified as intrinsic (e.g., muscle weakness, balance problems) and extrinsic (e.g., home hazards), most prevention programs target only intrinsic factors. We present the rationale and design of a home-based multicomponent fall prevention program-the LIVE LiFE program-for community-living older adults. The program adapts and expands the successful Lifestyle Intervention Functional Exercise (LiFE) program by adding home safety, vision contrast screening, and medication review. The specific aims of the study are to (1) adapt the LiFE program to a US context and expand it into a multicomponent program (LIVE LiFE) addressing intrinsic and extrinsic fall risks, (2) examine feasibility and acceptability, and (3) estimate program impact on multiple outcome measures to prepare for an efficacy trial. METHODS: The study involves two phases: an open-label pilot, followed by a two-group, single-blinded randomized pilot trial. Eligible participants are community-living adults 70+ years reporting at least one injurious fall or two non-injurious falls in the previous year. Participants are randomized in a 2:1 ratio to the program group (LIVE LiFE, n = 25) or the control group (written fall risk assessment, n = 12). The open-label pilot participants (n = 3) receive the program without randomization and are assessed based on their experience, resulting in a stronger emphasis on the participant's personal goals being integrated into LIVE LiFE. Fall risk and balance outcomes are assessed by the Timed Up and Go and the 4-Stage Balance Test at 16 weeks. Additional outcomes are incidence of falls and near falls, falls efficacy, fear of falling, number of home hazards, and medications assessed at 16 weeks. Incidence of falls and near falls, program adherence, and satisfaction are assessed again at 32 weeks. DISCUSSION: By expanding and adapting the evidence-based LiFE program, our study will help us understand the feasibility of conducting a multicomponent program and estimate its impact on multiple outcome measures. This will support moving forward with an efficacy trial of the LIVE LiFE program for older adults who are at risk of falling. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03351413 . Registered on 22 November 2017.

Household Accessibility and Residential Relocation in Older Adults.

OBJECTIVES: It is unclear how home environmental factors influence relocation decisions. We examined whether indoor accessibility, entrance accessibility, bathroom safety features, housing type, and housing condition were associated with relocations either within the community or to residential care facilities. METHODS: We used prospective data over 4 years from the nationally representative National Health and Aging Trends Study in the United States of Medicare beneficiaries 65 years and older living in the community (N = 7,197). We used multinomial regression analysis with survey weights. RESULTS: Over the 4 years, 8.2% of the population moved within the community, and 3.9% moved to residential care facilities. After adjusting for demographics and health factors, poor indoor accessibility was found to be associated with moves within the community but not to residential care facilities. No additional home environmental factors were associated with relocation. DISCUSSION: One-floor dwellings, access to a lift, or having a kitchen, bedroom, and bathroom on the same floor may help older adults age in place. Understanding which modifiable home environmental factors trigger late-life relocation, and to where, has practical implications for developing policies and programs to help older adults age in their place of choice.

Housing accessibility for senior citizens in Sweden: Estimation of the effects of targeted elimination of environmental barriers.

AIM: To estimate the effects of targeted elimination of environmental barriers (EB) in the ordinary housing stock in Sweden, and to explore the estimated effects on accessibility at a population level in relation to (a) residents with different functional profiles, (b) different housing types and (c) building periods. METHOD: Data on dwellings from existing Swedish research databases were utilized. EB and accessibility were assessed by means of the Housing Enabler instrument. In simulations of EB removal, five items that correspond to the most common housing adaptations were selected. The simulations were applied to four functional profiles of different complexity. RESULT: EB known to be commonly removed by housing adaptations exist in large proportions of the existing ordinary housing stock. Estimated targeted elimination of selected barriers would have the largest accessibility effects for the more complex functional profiles. The effects would be consistently larger for one-family houses, and for all types of dwellings built before 1960. CONCLUSIONS: The elimination of the EB most commonly addressed by housing adaptations could result in a reduction of the housing accessibility problems that community-living older people are facing. For society to solve the housing situation for the ageing population well-informed and efficient upgrading of ordinary housing is imperative.

Effects on leisure activities and social participation of a case management intervention for frail older people living at home: a randomised controlled trial.

Frailty causes disability and restrictions on older people's ability to engage in leisure activities and for social participation. The objective of this study was to evaluate the effects of a 1-year case management intervention for frail older people living at home in Sweden in terms of social participation and leisure activities. The study was a randomised controlled trial with repeated follow-ups. The sample (n = 153) was consecutively and randomly assigned to intervention (n = 80) or control groups (n = 73). The intervention group received monthly home visits over the course of a year by nurses and physiotherapists working as case managers, using a multifactorial preventive approach. Data collections on social participation, leisure activities and rating of important leisure activities were performed at baseline, 3, 6, 9 and 12 months, with recruitment between October 2006 and April 2011. The results did not show any differences in favour of the intervention on social participation. However, the intervention group performed leisure activities in general, and important physical leisure activities, to a greater extent than the control group at the 3-month follow-up (median 13 vs. 11, P = 0.034 and median 3 vs. 3, P = 0.031 respectively). A statistically significantly greater proportion of participants from the intervention group had an increased or unchanged number of important social leisure activities that they performed for the periods from baseline to 3 months (93.2% vs. 75.4%, OR = 4.48, 95% CI: 1.37-14.58). Even though statistically significant findings in favour of the intervention were found, more research on activity-focused case management interventions is needed to achieve clear effects on social participation and leisure activities.