Integrated Care For Older People Research Articles

Prevention of frailty

The presence of frailty in older patients increases the risk for adverse health events and for aloss of independence. Measures for the prevention of this geriatric syndrome should be incorporated into routine healthcare. What types of interventions could be effective in the prevention of frailty and how can preventive strategies be successfully implemented? Narrative review article. The concept of frailty is multidimensional and potential starting points for aprevention of frailty can be found within different dimensions (e.g., dimensions of physical activity and nutrition, psychosocial dimension). Epidemiological analyses have identified factors that increase or decrease the risk for becoming frail. Evidence from randomized controlled trials that examined the effectiveness of specific interventions in the prevention of frailty is still limited. Based on the available data, interventions using physical exercise appear to be effective in preventing frailty. In primary care in Germany the frailty status of older patients is not yet routinely recorded, which impedes the identification of patients at risk (patients with pre-frailty) and the implementation of targeted preventive strategies. The Integrated Care for Older People (ICOPE) concept of the World Health Organization offers apotential approach to prevent frailty and to promote healthy ageing within the population. The prevention of frailty is possible and reasonable. Comprehensive and targeted preventive strategies are yet to be implemented.

Delivering Integrated Care for Older People – A Feasibility Study on Online Training of Master Trainers

Abstract Introduction: The World Health Organization has advocated the training of healthcare workers in providing integrated care for older people (ICOPE). Due to physical and financial barriers, training through online mode was adopted. The aim of this study was to evaluate the acceptability, feasibility and effectiveness of the online ICOPE training programme. Subjects and Methods: It was an observational study and 102 doctors from seven South Asian countries were imparted ICOPE training online. Knowledge was tested through multiple-choice questions. Feedback was taken through a structured online questionnaire after each session and after 1 year. Results: About 88.4% found the session satisfactory to excellent for grasping the concept. Seventy-nine per cent of participants rated the session interaction to be satisfactory to excellent. About 91.8% of participants rated the utility of the session as satisfactory to excellent as a future master trainer. Participants demonstrated significant improvement in knowledge post-training (mean difference of 3.6 ± 2.8; P < 0.001). Post 1-year responses remained positive with 91.3% using the course materials and skills, and 82.6% providing further training to other doctors. Conclusions: The online training programme is feasible and effective in imparting ICOPE training.

Mapping the way: functional modelling for community-based integrated care for older people

BackgroundHealthcare system sustainability is challenged by several critical issues; one of the most pressing is the ageing population. Traditional, episodic care delivery models are not designed for older people who are medically complex and frail. These individuals would benefit from health and social care that is more comprehensive, coordinated, person-centred and accessible in the communities in which they live. Delivering this is a challenging endeavour. Community-based health and social care professionals are siloed, dispersed across various locations and sectors, each with their own mental models, electronic health information systems, and means of communication. To move away from fragmented care delivery models and towards a more integrated approach to care, an analysis of the process of community-based comprehensive geriatric assessment was conducted in an urban location in Atlantic Canada. The purpose of the study was to identify where in the community-based comprehensive geriatric assessment process challenges and opportunities existed for moving towards a more integrated model of care delivery.MethodThe functional resonance analysis method (FRAM) and dynamic FRAM (DynaFRAM) modelling were used to model the community-based health and social care system and create a hypothetical patient journey scenario. Data collected to inform modelling consisted of document review, focus groups, and semi-structured interviews with health and social care professionals providing care and service to older people in the community setting.Findings.Challenges and opportunities for implementing integrated care in the local context were identified. Findings from the FRAM and DynaFRAM analysis informed the co-design of multi-level process improvement recommendations that aim to move the local community-based comprehensive geriatric assessment process towards a more integrated model of care.ConclusionsA transformative redesign of community-based health and social care in the local context is necessary but cannot be accomplished without an understanding of how health and social care professionals conduct their work and how older people may receive care under the dynamic conditions. The FRAM and DynaFRAM modelling provided an enhanced understanding of system operations and functionality and demonstrated a critical step that should not be overlooked for decision-makers in their efforts to implement a more integrated model of care.

Exploring ICOPE's Impact on Delaying Elderly Disability Management.

The purpose of this study was to explore the initial benefits of introducing the ICOPE (Integrated care for older people) information assessment system for the management of hospitalized elderly patients in a teaching hospital in Eastern Taiwan. The ICOPE information assessment system was set up for case screening and abnormal referral through clinical ICOPE, followed by follow-up and case management. The results showed a total of 3424 screened cases, an average of 311 ICOPE screenings per month, an average of 48 abnormal screenings per month (15%), a referral rate of 79%, a rescreening rate of 91%, and a case management completion rate of 71%. Conclusion: Introducing the ICOPE information evaluation system can quickly screen for potential abnormal disability cases in hospitalized elderly patients, timely referral case management, provide appropriate intervention measures, and improve the quality of life after returning home in old age.

Predictive Validity of Intrinsic Capacity Composite Scores for Risk of Frailty at 2 Years: A Comparison of 4 Scales

ObjectiveIntrinsic capacity (IC) and frailty are complementary constructs that encapsulate functional capacities of older adults. Although earlier studies suggest the utility of composite IC scores in predicting risk of frailty, key gaps remain with the lack of direct comparative studies between different IC scales and lack of a composite score based on the World Health Organization Integrated Care for Older People (ICOPE) tool. We aimed to compare different IC scales, including an ICOPE-based scale, in their predictive ability for risk of frailty at 2 years in healthy community-dwelling older adults. DesignCohort study. Setting and ParticipantsA total of 230 participants (age: 67.2 ± 7.4 years) from the GeriLABS-2 cohort study. MethodsWe derived composite scores by summing 4 IC domains (locomotion, cognition, vitality, and psychological). We compared composite scores of 4 scales: IC1-Chew 2021, range: 0–8; IC2-Liu 2021, range: 0–4; IC3-ICOPE, range: 0–4; IC4-modified ICOPE, range: 0–8. The primary outcome was risk of frailty using the modified Fried Frailty Phenotype. We performed logistic regression to examine the association of baseline composite IC with risk of frailty. We also examined the impact of individual domains and number of impaired domains on risk of frailty. ResultsAmong 193 (83.9%) older adults who completed 2-year follow-up, 20 (10.4%) met criteria for risk of frailty. When adjusted for covariates, 2-point per domain scales (IC1/IC4) predicted increased risk of frailty (OR, 4.31; 95% CI, 1.55–11.96; OR, 5.00; 95% CI, 1.75–14.26). When further adjusted for baseline frailty, only IC4 remained significant (OR, 4.28; 95% CI, 1.45–12.60). Among the domains, impaired locomotion and vitality were associated with risk of frailty. Greater number of impaired domains predicted increased risk of frailty (IC1/IC2: β = 0.18–0.19, P < .05). Conclusions and ImplicationsBaseline composite IC score using 2-point per domain scales better predicted risk of frailty at 2 years, predicated on impaired locomotion/vitality and greater number of impaired domains. For early identification of healthy older adults at risk of frailty, an ICOPE-based scale should be considered, as it is effective and accessible.

Assessing intrinsic capacity in Taiwan: Initial psychometric properties of the Integrated Care for Older People Screening Tool for Taiwanese (ICOPES-TW)

BackgroundThe World Health Organization (WHO) proposed the concept of intrinsic capacity (comprising composite physical and mental capacity) which aligns with their concepts of healthy aging and functional ability. Consequently, the WHO promotes the Integrated Care for Older People (ICOPE) framework as guidance for geriatric care. Consequently, each government should have a screening tool corresponding to ICOPE framework to promote geriatric care. The present study examined the initial psychometric properties of the Taiwan version of ICOPE (i.e., ICOPES-TW).MethodsOlder people (n = 1235; mean age = 72.63 years; 634 females [51.3%]) were approached by well-trained interviewers for participation. A number of measures were administered including the ICOPES-TW, WHOQOL-AGE (assessing quality of life [QoL]), Clinical Frailty Scale (assessing frailty), Barthel Index (assessing basic activity of daily living [BADL]), and Lawton Instrumental Activities of Daily Living Scale (assessing instrumental activity of daily living [IADL]).ResultsThe ICOPES-TW had a two-factor structure (body functionality [eigenvalue = 1.932] and life adaptation [eigenvalue = 1.170]) as indicated by the results of exploratory factor analysis. Internal consistency of the ICOPES-TW was low (Cronbach’s α = 0.55 [entire ICOPES-TW], 0.45 (body functionality factor), and 0.52 (life adaptation factor). ICOPES-TW scores were significantly (i) positively correlated with age (r = 0.321), IADL (r = 0.313), and frailty (r = 0.601), and (ii) negatively correlated with QoL (r=–0.447), and BADL (r=–0.447), with all p-values < 0.001.ConclusionThe ICOPES-TW could be a useful screening tool for healthcare providers to quickly evaluate intrinsic capacity for Taiwanese older people given that it has moderate to strong associations with age, BADL, IADL, QoL, and frailty.

Safeguarding vitality and cognition: The role of sarcopenia in intrinsic capacity decline among octogenarians from multiple cohorts

BackgroundSarcopenia and intrinsic capacity (IC) declines pose significant challenges to healthy aging, particularly in the rapidly growing octogenarian population. This study aimed to elucidate the relationship between sarcopenia and declines in IC across multiple cohorts of community-dwelling older adults. MethodsData from four Taiwanese cohorts were analyzed. Sarcopenia was diagnosed based on the Asian Working Group for Sarcopenia (AWGS) 2019 criteria (algorithm 1: categorized as either having possible sarcopenia or not (robust); algorithm 2: categorized as robust, possible sarcopenia or sarcopenia). IC was operationalized using the World Health Organization's Integrated Care for Older People (ICOPE) framework (step 1 and step 2), encompassing six domains: locomotion, vitality, vision, hearing, cognition, and psychological well-being. Multivariable logistic regression models were adopted to assess the association between sarcopenia and IC decline. ResultsAmong 599 octogenarians (median age 82.2 years, 54.8% male), the prevalence of possible sarcopenia (algorithm 1) was 64.6%. When adopting algorithm 2, the prevalence of possible sarcopenia and sarcopenia was 46,2% and 32.1%, respectively. After adjusting for covariates, participants with possible sarcopenia or sarcopenia (algorithm 2) were more likely to exhibit declines in vitality (ICOPE Step 1: possible sarcopenia aOR 3.65, sarcopenia aOR 4.74; ICOPE Step 2: possible sarcopenia aOR 5.11, sarcopenia aOR 14.77) and cognition (ICOPE Step 1: possible sarcopenia aOR 2.40, sarcopenia aOR 2.12; ICOPE Step 2: possible sarcopenia aOR 2.02, sarcopenia aOR 2.51) compared to robust individuals. ConclusionsThis study underscores the robust association between sarcopenia and declines in vitality and cognition among octogenarians, highlighting the importance of sarcopenia screening and management in promoting healthy longevity in this vulnerable population.

Geographical accessibility of medical resources, health status, and demand of integrated care for older people: a cross-sectional survey from Western China

BackgroundThe World Health Organization (WHO) published the Integrated Care for Older People (ICOPE) framework to help healthcare providers cope with the population aging crisis. However, the relevant evidence on the demands of older people and the compensatory capacity of the environment is limited. This study reports for the first time the level of the ICOPE demand in Western China that includes the impact of geographic accessibility of medical resources (GAMR) on ICOPE demand and the potential mechanism of health status.MethodsA cross-sectional questionnaire survey was conducted among 1200 adults aged 60 years and older selected through multi-stage stratified cluster sampling to obtain relevant data, including ICOPE demand, health status, and GAMR. Propensity score matching (PSM) was used to analyze the impact of GAMR on ICOPE demand among older people and those with different health statuses.ResultsAmong the prospective research participants, 1043 were eligible for the study. The mean score of ICOPE demand among all participants was 3.68 (standard deviation [SD] = 0.78). After adjusting for covariates between high and low GAMR groups (1:1 match), ICOPE demand was significantly higher in the low GAMR group than in the high GAMR group (average treatment effect on the treated [ATT] = 0.270, p < 0.05). For both good and poor self-rated health status, the ICOPE demand of the low GAMR group was significantly higher than that in the high GAMR group (ATT = 0.345, p < 0.05; ATT = 0.190, p < 0.05). For chronic diseases, the ICOPE demand of older people with multimorbidity in the low GAMR group was significantly higher than that in the high GAMR group (ATT = 0.318, p < 0.01).ConclusionsThe older population in Western China has a relatively high demand for ICOPE. Low GAMR is a key factor in ICOPE demand growth in this region. It accelerates demand release for both older people with multimorbidity and self-perceptions of health.

Towards Integrated Care for the Elderly: Exploring the Acceptability of Telemonitoring for Hypertension and Type 2 Diabetes Management.

Telemonitoring has been proposed as an effective method to support integrated care for older people with hypertension and type 2 diabetes. This paper examines acceptability of telemontioring, its role in supporting integrated care, and identifies scale-up barriers. A concurrent triangulation mixed-methods study, including in-depth interviews (n = 29) and quantitative acceptability tool (n = 55) was conducted among individuals who underwent a 12-month telemonitoring routine. The research was guided by the Theoretical Framework of Acceptability. Interviews were analysed using template content analysis (TCA). TCA identified seven domains of acceptability, with twenty-one subthemes influencing it positively or negatively. In the quantitative survey, acceptability was high across all seven domains with an overall score of 4.4 out of 5. Urban regions showed higher acceptability than rural regions (4.5 vs. 4.3), with rural participants perceiving initial training and participation effort as significantly more burdensome than their urban counterparts. Patients described several instances where telemonitoring supported self-management, education, treatment, and identification elements of the integrated care package. However, there were barriers that may limit its further scale-up. For further scale-up, it is important to screen patients for monitoring eligibility, adapt telemonitoring devices to elderly needs, combine telemonitoring with health education, involve family members, and establish follow-up programmes.

Predictive capacity of the Integrated Care for Older People (ICOPE) screening tool for intrinsic capacity impairments: results from the INSPIRE-T cohort.

The Integrated Care for Older People (ICOPE) approach was developed by the World Health Organization (WHO) aiming to shift the traditional focus of care based on diseases to a function- and person-centered approach, focused on maintaining and monitoring intrinsic capacity (IC). This study aimed to investigate the ability of the ICOPE screening tool to identify older people with clinically meaningful impairments in IC domains. This cross-sectional analysis included 603 older adults, participants (mean age 74.7 [SD 8.8] years, women 59.0%) of the INSPIRE Translational (INSPIRE-T) cohort. Responses at screening were compared to results of the subsequent in-depth assessment (i.e., Mini Mental State Examination, Mini Nutritional Assessment, Short Physical Performance Battery, Patient Health Questionnaire-9, and clinical investigation of vision problems) to determine its predictive capacity for impairments at the IC domains (i.e., cognition, psychological, sensory (vision), vitality, and locomotion). The ICOPE screening items provided very high sensitivity for identifying abnormality in vision (97.2%), and varied from 42.0% to 69.6% for the other domains. High specificity (>70%) was observed for all the IC domains, except for vision (2.7%). The ICOPE screening tool can be a useful instrument enabling the identification of older people with impairments in IC domains, but studies with different populations are needed. It should be considered as a low-cost and simple screening tool in clinical care.

Effectiveness of integrated person-centered interventions for older people's care: Review of Swedish experiences and experts' perspective.

Older adults have multiple medical and social care needs, requiring a shift toward an integrated person-centered model of care. Our objective was to describe and summarize Swedish experiences of integrated person-centered care by reviewing studies published between 2000 and 2023, and to identify the main challenges and scientific gaps through expert discussions. Seventy-three publications were identified by searching MEDLINE and contacting experts. Interventions were categorized using two World Health Organization frameworks: (1) Integrated Care for Older People (ICOPE), and (2) Integrated People-Centered Health Services (IPCHS). The included 73 publications were derived from 31 unique and heterogeneous interventions pertaining mainly to the micro- and meso-levels. Among publications measuring mortality, 15% were effective. Subjective health outcomes showed improvement in 24% of publications, morbidity outcomes in 42%, disability outcomes in 48%, and service utilization outcomes in 58%. Workshop discussions in Stockholm (Sweden), March 2023, were recorded, transcribed, and summarized. Experts emphasized: (1) lack of rigorous evaluation methods, (2) need for participatory designs, (3) scarcity of macro-level interventions, and (4) importance of transitioning from person- to people-centered integrated care. These challenges could explain the unexpected weak beneficial effects of the interventions on health outcomes, whereas service utilization outcomes were more positively impacted. Finally, we derived a list of recommendations, including the need to engage care organizations in interventions from their inception and to leverage researchers' scientific expertise. Although this review provides a comprehensive snapshot of interventions in the context of Sweden, the findings offer transferable perspectives on the real-world challenges encountered in this field.

Insights Into Geriatric Care and Healthy Ageing

The global population of older adults is expanding rapidly. According to the United Nations world social report (2023), 1 in 10 people worldwide were aged 65 or above in 2021. In 2050, this age group is projected to account for 1 in 6 people globally. In 2019, 9.6% of the Lebanese population were above 65 years of age according to statistics of the Ministry of Health. Geriatric medicine plays a vital role in enhancing the quality of life for older adults, as it drives health promotion and disease prevention and treatment. The last two decades have witnessed a lot of progress in this field due to advancement on personalized care driven by genomic analysis, comprehensive geriatric assessment, polypharmacy management, assessment of frailty to prevent cognitive decline and nutrition and exercise interventions to maintain muscle and bone health and cognitive function. Yet, a lot of aspects need to be explored, as complex multimorbidity in this age group requires coordinated care across specialties. In addition, evidence-based studies that include older adults are limited. To tackle the different aspects of geriatric care, Beirut Arab University-Tripoli branch hosted the conference entitled “Insights into Geriatric Care and Healthy Ageing” which featured a series of keynote speeches, sessions, and discussions led by esteemed experts in the fields of Ageing and healthcare. The conference was organized in collaboration with the Middle East Academy for Medicine of Ageing (MEAMA) and the International Institute on Ageing (INIA). The first session held by Dr. Abdul Razzak Abyad and Dr. Nabil Kronfol addressed the medical and social transformation of ageing, the major challenges faced by older people and proposed a comprehensive program to improve the health and well-being of older people. A session entitled “Update on Geriatric Medicine” reflected a comprehensive approach to understanding and managing common health challenges associated with Ageing and offered the latest medical protocols and treatment to improve patient outcomes. The topics included the management of Metabolic Syndrome and Parkinson’s Disease, clinical presentation and management of depression in older adults, prevention and control of urinary tract infections in elderly, medication management to prevent polypharmacy, in addition to bone healthcare to prevent osteoporosis and fracture. A session specified for dementia and delirium covered the latest update on diagnosis and management of dementia, the progress in the process of using genetic markers for diagnosis of Alzheimer’s Disease, and nursing care tools used in the screening of delirium. Another session focused on prevention, assessment, and nursing care management protocols of pressure injuries in addition to surgical treatment. The concept of “healthy ageing” and the maintenance of physical health was highlighted during the conference through a talk about frailty prevention and management, which extensively covered the different types of exercise recommended in older age, their benefits, and the conditions of each. In addition, another talk linked the different dietary patterns to the risk of frailty and cognitive decline in older adults according to a Lebanese national study. The last session of the conference was dedicated to policies and programs of elderly healthcare. Dr. Samar El Feky, Regional Focal Person for Health of Older People from the Eastern Mediterranean Regional Office of the World Health Organization, introduced the WHO guidelines for integrated care for older people (ICOPE) program implemented in several countries in the region. On the other hand, Dr. Saadallah Sabouneh presented the elderly care policies and programs in Lebanon, on behalf of the Minister of Health, Dr. Firas Abyad. The president of the order of nurses, Dr. Rima Sassine Kazan, presented the challenges of Nursing care for the elderly in Lebanon. The conference was concluded by the organizers who emphasized the significance of “healthy ageing”, the process of maintaining functional ability as people grow older to enable their continued participation in society.

Healthy Aging in Algoma: Tests of Change Program

Introduction: In Algoma District, Ontario, Canada, approximately 25% of the population is 65 years of age and older. The Ontario Provincial Geriatrics Leadership Office (2020) predicts that by 2040 this number will increase to 32% and that 29% of older adults will be living with frailty. In February of 2022, Tests of Change (ToC) Program work commenced to bring an integrated care approach to healthy aging in Algoma. Healthcare member organizations of the Algoma Ontario Health Team (AOHT) and community patient, family, and caregiver advisors identified older adults living with frailty as the target population. A driver diagram of change ideas was conceptualized to support improving care for the identified population. To enact the recommended changes, three priority projects - Outpatient Geriatric Rehabilitation Capacity, Coordinated Access to Geriatric Services and Early Frailty Identification - complement each other with the common purpose of improving early frailty intervention and increasing access to the most appropriate care.&#x0D; Aims: The ToC Program entails:&#x0D; Embedding a frailty screening tool into electronic medical records for use in primary care;&#x0D; Initiating coordinated access to geriatric services leveraging eReferral and a common platform for electronic referral management; and&#x0D; Designing an outpatient geriatric rehabilitation program.&#x0D; This Program aims to advance the following elements:&#x0D; Design upstream engagement strategies (e.g., screening, prevention, disease self-management) for the target population;&#x0D; Increase patient access to the appropriate level of care; and&#x0D; Transform care coordination, transitions and recovery at home.&#x0D; Highlights: The AOHT has engaged partners from across the continuum of care who provide services for frail older adults. Partners include: community support services, home and community care support services, primary care, acute care, specialized geriatric services, and patient advisors. These critical partners assume leadership roles in program design, implementation and evaluation.&#x0D; Conclusions: Early frailty identification can improve quality of life, increase intervention success, and delay the need for specialist care. This program is predicated on the establishment of foundational processes enabled by digital tools to identify frailty early, streamline referrals for access to the most appropriate geriatric services, and provide patients with the opportunity to fully participate in interventions such as outpatient geriatric rehabilitation to increase their ability to live independently in the community. By taking an integrated collaborative approach to program planning and execution, overall patient outcomes will be improved.&#x0D; Transferability: The WHO Guidelines on Integrated Care for Older People (ICOPE) recommend advancing integrated care through community collaboration, a patient centered approach and supportive leadership. In 2019, the Ontario Health Team (OHT) model was introduced provincially as a way for healthcare providers to partner to deliver coordinated, integrated care. Of significance, several of the 54 approved OHTs have identified older adults living with frailty as a target population. Globally, as older adults are living longer lives, it is anticipated that there will be proportionally more older adults living with frailty. Through collaboration and sharing of the ToC program results, program scalability can be achieved at the OHT level and support the global knowledge base on efforts to strengthen integrated care for older adults.

Factors associated with informal, and professional care, and unmet care needs in persons with deficits in activities of daily living in Austria. Results of two repetitive population-based surveys in people aged ≥65 years.

Introduction: Europe’s population is growing older, a trend that is projected to continue. Increased life expectancy means, older individuals are at risk of falls, hip fractures, long-term health conditions, re-hospitalization, which leads to the possibility of increased time spent in poor health. Hence, it is paramount to identify the diverse factors influencing the ageing process and subsequent limitation in Activities of Daily Living (ADLs)—eating and drinking independently, getting up and sitting down, dressing and undressing, using the toilet, and bathing or showering. Evidence shows worsening disability and developing new difficulty in ADLs has become more common with age, and leads to reduced quality of life, loss of independence and increased dependency and the increased need for care.&#x0D; Methods: Data was obtained from the Austrian Health Interview Surveys. 2931 and 2922 study participants aged ≥65 from 2014 and 2019, respectively, were included in the analysis. Three binary logistic regression was conducted with informal care, professional care and unmet care needs as dependent variable, and socio-demographic, health-related, and lifestyle-related parameters as independent variables, and the latter were mutually adjusted for each other.&#x0D; Results: In 2014, 12.8% of men and 17.9% of women, respectively, had difficulty in at least one ADL domain, compared to 19.2% and 25.7%, in 2019 (p&lt;0.001). Of men and women with ADL deficits, 50.2% and 50.0% sought help from family members or friends, 14.1% and 27.5% received help from professional caregivers, and 17.4% and 30.4% said they would need more help than they actually get. The probability of both informal and professional care with ADL deficits increased significantly from 2014 to 2019 (OR; 95% CI: 1.88; 1.47-2.41; 2.42; 1.76 -3.33), however, there was no change in unmet care needs (1.06; 0.81-1.39). Male sex was associated with professional care (1.67; 1.16-2.40) and unmet care needs (2.04; 1.48-2.82). Higher age was associated with all three measures of care (2.54; 1.96-3.30; 2.77; 2.00-3.85; 2.09; 1.56-2.79). Lower education was associated with informal care (2.90; 1.57-5.35 for primary education; 2.53; 1.38-4.64 for secondary education). Being born in other European states (EU or EFTA) was associated with a higher chance for professional care (3.11; 1.93-5.02) and unmet care needs (1.90; 1.22-2.95). Living in a big city was negatively associated with informal care (0.60; 0.44-0.83). Not living in a relationship was negatively associated with informal (0.55; 0.42-0.73) and positively with professional care (2.18; 1.56-3.06). Having at least one chronic disease was associated with informal care (2.16; 1.56-3.00) and unmet care needs (2.56; 1.69-3.88). Lack of physical activity was associated with all three care parameters (2.90; 1.32-4.28; 11.87; 2.03-69.45; 2.09; 1.02-4.29). Being underweight was associated with a higher chance for informal care (3.33; 1.11-10.01), and obesity with unmet care needs (1.49; 1.05-2.13).&#x0D; Conclusions: Socio-economic, health and lifestyle-related factors are significantly associated with formal and professional and unmet care needs in older people with ADL deficits. To deliver a sustainable integrated care for older people in Europe, the importance of physical health, social, cultural, and emotional needs must be recognized and supported in all levels of care.

INTRINSIC CAPACITY OF OLDER ADULTS IN SINGAPORE USING WHO INTEGRATED CARE FOR OLDER PEOPLE (ICOPE) FRAMEWORK

Abstract The World Health Organization (WHO) proposed the Integrated Care for Older People (ICOPE) approach to guide health systems in better supporting the intrinsic capacity and functional ability of older adults to enable healthy aging (Briggs et al., 2018; de Carvalho et al., 2019). This approach is aligned with Singapore’s Healthier SG initiative, which aims to build a good healthcare system that promotes better health and quality of life for everyone. Recent studies have shown that older adults experience intrinsic capacity decline in various countries, including Singapore, highlighting the importance of targeted interventions to maintain functionality and quality of life in old age (Beard et al., 2019; Liu et al., 2021; Tay et al., 2022). In this cross-sectional study, 367 participants were assessed by 43 ICOPE assessors, of whom 77.4% (n=284) had impairments in intrinsic capacity. The three most prevalent intrinsic capacity impairments were visual impairment (42%), hearing loss (33.5%), and cognitive decline (31.3%), followed by limited mobility (24.3%), malnutrition (16.1%), and depressive symptoms (16.1%). Furthermore, 22.6% of participants were unaware of any elderly care services available in the community, and 8.2% did not know where to seek help in case of problems. These findings emphasize the need for ICOPE assessments at the community level to promote early detection of intrinsic capacity impairments and interventions. More discussion of the care pathway, together with health professionals, older adults, and caregivers, should be the next step to offer diagnostic assessment and guide self-management of intrinsic capacity impairment for among older adults.

Assessing the Professional Knowledge of Long Term Care Stations around the Blocks Personnel from the Perspective of Integrated Care for older People (ICOPE): An Example from Puli Christian Hospital

&lt;p&gt;C級巷弄長照站是長者照護的最前端場域，目前整合照護資源及服務素質不齊，影響長照2.0照護之實踐。本文以世衛組織高齡整合照護指南為基準，檢視埔基巷弄長照站現況與人才培育困境。埔基長照站宜再補強的知能包括：建立高齡整合照護的評估系統及追蹤報告，宜增加老人虐待、老人歧視，以及衛生教育技能課程，宜增強制定完整的照顧計畫，以及強化志工服務量。在行政上應加強：應建立長輩一站式整合服務模式、建立正式通報及轉診之服務系統，以及結合多元輔助產品，用於知能教學或服務品質。政府公共政策建議：宜加強照顧服務員之知能；以區域為基礎，盤點可提供之服務，以達公平性服務；提供跨專業整合及全面的照護計畫；鼓勵由下而上發展政策。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;The Long Term Care (LTC) Stations around the Blocks is the primary prevention front for the elderly in the community. However, the resources and quality of multidisciplinary integrated care vary. According to the implementation framework of ICOPE, the current ability of the LTC station around the blocks to implement procedures outlined by ICOPE and impediments to staff training are examined in this study. Puli LTC Station staff should enhance their knowledge and skills in various areas, including systematic recruitment and case screening, implementing an ICOPE evaluation system with follow-up tracking, providing new training content on elder abuse and discrimination against the elderly, and improving health education for staff to create comprehensive care plans, expand volunteer recruitment, and increase volunteer training and service hours. Public policy recommendations aim to strengthen care abilities and promote regional equity, to provide integrate interdisciplinary care plans and advocate bottom-up policy development for adaptive service models.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Readiness for Integrated Care of Older People: A Cross-Sectional Study in Mexico.

To evaluate the readiness of the Mexican healthcare system to implement the integrated care for older people (ICOPE) approach into an existing healthcare model. We conducted a cross-sectional study with data from 2473 healthcare workers analyzed using the model for understanding success in quality (MUSIQ) framework to gather data from healthcare professionals. Their perceptions regarding the readiness for ICOPE were assessed across five dimensions: team, microsystem, infrastructure, organization, and external environment. Only 717 (29%) of the participants believed ICOPE could be successfully implemented in Mexico without any modifications. A total of 1261 (51%) participants rated the readiness of ICOPE with some barriers. The main barriers were reallocating resources and the external environment. Mexico's healthcare system faces barriers to innovation that could hinder the successful integration of the ICOPE approach. A systematic identification of these barriers provides an opportunity to suggest adaptations and refinements to increase the probability of success. Using the contextual factors identified as facilitators and the proposal of interventions such as the ICOPE app could improve the chances of success. The participants of this study evaluated ICOPE as ready to implement, with some contextual barriers. The readiness evaluation supports the stakeholders' and policymakers' decisions in implementing and monitoring the program in a natural setting. Evaluating the readiness of the intervention increases the possibility of aligning the innovation with contextual factors, increasing the chances of its successful adoption and implementation.

A Case Study in Implementing Integrated Care for Older People in Ireland; Getting from Complex Challenge to Complex Adaptation

A Case Study in Implementing Integrated Care for Older People in Ireland; Getting from Complex Challenge to Complex Adaptation

The sensitivity and specificity of the WHO's ICOPE screening tool, and the prevalence of loss of intrinsic capacity in older adults: A scoping review.

The World Health Organization has developed the Integrated Care for Older People (ICOPE) program, a public health strategy to maintain older adults' functional abilities and promote healthier aging. The approach comprises a 5-step pathway. Step 1 is the screening for impairment in functions, and Step 2 is an in-depth evaluation to confirm the presence and severity of functional impairment. These initial two steps are crucial to determine the subsequent plan of care (Step 3) and follow-up (Step 4). The fifth step encompasses actions to support families and caregivers and to engage communities. This review gathers data from the literature on the prevalence of positive screenings regarding intrinsic capacity detected by the program's first-step screening tool, and on currently available results regarding the instrument's sensitivity and specificity. Electronic searches were conducted in the PubMed, Cochrane, Embase, and SciElo databases, the medRxiv platform, and recent human aging scientific events, looking for research analyzing the ICOPE screening instrument. Studies reporting data on the prevalence of positive screenings for loss of intrinsic capacity using the proposed screening tool and/or findings on the instrument's sensitivity and specificity were included. A total of 7 publications with participants aged 50years or more were selected. The prevalence of at least one impairment in intrinsic capacity detected by the instrument varied among the studies from 17.1% to 94.3%. Sensitivity ranged from 26.4% to 100% and specificity from 22% to 96%, depending on the setting and the assessed domain. Currently available data are heterogeneous, and different results were found among the studies due to diverse settings and methodologies. The evidence on the ICOPE screening tool's performance in different populations is still scarce and reinforces the need for further research worldwide.

Relationship between intrinsic capacity and health-related quality of life among community-dwelling older adults: the moderating role of social support.

To examine how social support might moderate the relationship between intrinsic capacity and health-related quality of life (HRQoL) based on the buffering model of social support. This was a cross-sectional study with a sample of 1181 Chinese community-dwelling older adults aged ≥ 60years in 2016. Social support was assessed using the Social Support Rating Scale. Intrinsic capacity was assessed using the revised integrated care for older people screening tool. HRQoL was measured by the 12-item Short Form Health Survey. Hierarchical linear regression analysis was implemented to test the moderating effect of social support. Support utilization attenuated the relationship between lower intrinsic capacity and poor physical HRQoL while subjective support attenuated the relationship between lower intrinsic capacity and poor mental HRQoL. However, objective support had no significant moderating effect on the relationship between intrinsic capacity and specific domains of HRQoL. The moderating effects of social support on the association between intrinsic capacity and HRQoL vary by support types. Effective interventions should target the perception and utilization of available support among older adults with lower intrinsic capacity to maintain their physical and mental HRQoL.