1. Epidemiologic characteristics
Participation barriers-and frailty related items
in a cohort of older people in rural Crete with low MMSE
University of Crete (a partner in the MISTRAL COMMITMENT of the A3 group of the EPI AHA) Program Thales-Multidisciplinary Network for the Study of Alzheimer's Disease in Rural Areas
Preliminary data from our research on cognitive and physical frailty in the rural area of Crete, as well as the participation barriers we faced during the process.

2. Disclosure LAGOUTA, HERAKLION, CRETE , GREECE

3. VILLAGES : Heraklion

4. Overall Aims of the study
At the Clinical level:
Establishment of a multidisciplinary network (Center of Excellence at the University of Crete) of experts (geriatricians-neurologists-psychiatrists-general practitioners-psychologists) in dementia diagnosis and treatment
At the Educational level:
Development of a Comprehensive geriatric method for assessment of older people with cognitive impairment
and implementation of educational programs for primary health care providers
Aims of the study at a clinical and educational level were:
Establish a multidisciplinary network of experts in dementia diagnosis and treatment
Develop a comprehensive assessment model of people with cognitive impairment
Implement educational programs for primary health care providers

5. Overall Aims of the study
At the Research level:
Create a longitudinal cohort of elders in rural areas of Crete and develop a clinical and genetic information database of well characterized individuals with cognitive impairment linked to a DNA bank in order to
Detect factors associated with healthy aging
Evaluate risk factors for frailty and cognitive decline
The intention on a research level was to create a longitudinal cohort of elders in rural Crete, develop a clinical and genetic information database of well characterized individuals with cognitive impairment linked to a DNA bank in order to detect factors associated with healthy aging or risk factors for frailty and cognitive decline such as …
Dietary habits
Stress, depression
Alcohol , smoking
Sleep patterns
Physical activity
Genetic and epigenetic factors
Social connectivity

6. Figure 1: Overall participants
N=3579 persons asked to participate Phase A
N=3220 (90%) accepted & participated Phase A
N=359 (10%) refused to participate Phase A
N=667 (20.7%) met criteria to participate Phase B
N=2553 (79.3%) did not meet criteria to participate Phase B
3579 individuals aged 60 and over who visited the primary health care centers/clinics (PHC) of certain villages, independently of reason, were asked to participate in a screening program for memory using MMSE (response rate 90%) accepted the screening
667 individuals among them with a MMSE <23/30 or <24/30 according to their level of education were eligible to participate in phase B assessment. Only 402 of them (participation rate 60%) accepted to be referred.
N=402 (60.3%) accepted & participated Phase B
N=265 (39,7%) refused to participated Phase B

7. Phase A: Reasons of refusal to Participate Phase B
Presented in order of frequency (rough estimation)
“I am ok”, “I do not need any further tests”
“I am tired of doctors and I do not like the system”
“I have other more important problems to deal with (family problems or other medical issues)”
Inconvenience, “no way to get to the clinic and I don't want the doctor to come to my house”
Participation rates were similar between males and females (60%)
Mean age of participants was 77.6 years and of non participants 78.6
In a semi-structured telephone interview, by rough estimation, the main answers of refusal were

8. Higher education, greater number of comorbidities and a surviving spouse predict higher likelihood for phase B participation
Logistic regression predicting the odds of an eligible person to participate in the second phase of the program (n=643 included in the model)
Variable
Odds ratio
95% CI
p-value
Male gender
1.08
0.72 – 1.59
0.709
Age (years)
0.98
0.96 – 1.01
0.239
MMSE score
1.00
0.96 – 1.05
0.777
Number of chronic conditions >3
1.14
1.05 – 1.25
0.003
Widowed or divorced
0.51
0.31 – 0.84
0.008
Less than 6 years of education
0.63
0.45 – 0.89
Katz index ≥4/6
0.52 – 10.08
0.176
Higher education, greater number of morbidities, a surviving spouse predict higher lickelihood for participating in phase B

9. Phase B : Significantly higher rates of exhaustion, physical slowness and stationary life style among participants with dementia (SHARE * Frailty items)
p = .014
p = .6
p = .006
p = .0001
* SHARE Instrument for Primary Care from the Survey of Health, Ageing and Retirement in Europe

11. ACTIONABLE LESSONS & NEXT STEPS
TRAINNING OF PRIMARY CARE HEALTH PERSONNEL
CREATE MOBILE UNITS FOR ACCESABILITY
USE OF e HEALTH TOOLS
CITIZEN TRAINING IN USE ON SOCIALBE MEDIA FOR CONNECTIVITY, KNOWLEDGE, LITERACY
COMMUNITY INVOLVENT IN MEANGFUL ACTIVITIES [environment, creative arts, spirituality]
REGIONAL AUTHRORITY INVOLVEMENT & private enterprises

12. Channeling Change Model MISTRAL COMMITMENT EPI AHA

13. Many thanks Participants from the villages
Primary Healthcare practitioners
All the members of Thales Team
Chariklia Tziraki-Segal, Director of Melabev Research and Evaluation Unit and HEBREW U, Israel, & ALLILEGI NGO , Heraklion, Crete, Greece

14. Thales Team
Symeon Panagiotakis1, Simos Panagiotis2, Bertsias Αntonios3, Fountoulakis Nick1 , Giakka Maria1, Zaganas Ioannis4, Kapetanaki Stefania3, Basta Maria5, Koutentaki Eirini5, Τziraki Sophia2,  Duijker George3, Manassaki Cynthia3, Lionis Christos3, Plaitakis Andreas4, Tziraki-Segal Chariklia6, Boumpas Dimitrios7 , Vgontzas Alexandros4
1. Department of Internal Medicine University General Hospital of Heraklion, Crete, Greece 2. Department of Clinical Psychiatry Medical School University of Heraklion Crete, Greece 3. Clinic of Social and Family Medicine Faculty of Medicine University of Crete, Greece Department of Neurology University General Hospital of Heraklion Crete, Greece 5. Department of Psychiatry University General Hospital of Heraklion Crete, Greece ALLILEGI, NGO , HERAKLION , CRETE , GREECE & Melabev Research and Evaluation Unit and Hebrew University, Israel th Department of Medicine Medical School University of Athens, Greece

15. Primary healthcare clinic in rural Crete
The Program has been co-financed by the European Union (European Social Fund - ESF) and Greek national funds through the Operational Program “Education and Lifelong Learning” of the National Strategic Reference Framework ( )
Cretan Medical School