In 2017 the World Health Organisation (WHO) published Integrated care for older people (ICOPE) guidelines on community-level interventions to manage declines in intrinsic capacity.

Definitions

The guidelines considered the concepts of intrinsic capacity and functional ability, which were defined as follows:

  • Intrinsic Capacity (IC) – the combination of an individual’s physical, mental and psychological capacities.
  • Functional Ability (FA) – the combination and interaction of Intrinsic Capacity with the environment a person inhabits.

Both IC and FA decline with age but the rate and severity of the decline depends upon variables such as underlying long term conditions, other diseases and genetic factors. Also, generally the gap between IC and FA will be wider in older people living with frailty than those without for any age, and that gap defines the amount of dependency or need for supported self-care for that individual.

Recommendations

The report set out 13 recommendations for managing declines in intrinsic capacity in older people, grouped into 6 priorities. In addition to the recommendations, the full report includes considerations for each recommendation.

Improve musculoskeletal function, mobility and vitality

  • Multimodal exercise, including progressive strength resistance training and other exercise components (balance, exibility and aerobic training) should be recommended for older people with declining physical capacity, measured by gait speed, grip strength and other physical performance measures
  • Oral supplemental nutrition with dietary advice should be recommended for older people affected by undernutrition.

Maintain sensory capacity

  • Older people should receive routine screening for visual impairment in the primary care setting, and timely provision of comprehensive eye care
  • Screening followed by provision of hearing aids should be offered to older people for timely identi cation and management of hearing loss

Prevent severe cognitive impairment and promote psychological well-being

  • Cognitive stimulation can be offered to older people with cognitive impairment, with or without a formal diagnosis of dementia
  • Older adults who are experiencing depressive symptoms can be offered brief, structured psychological interventions, in accordance with WHO Mental Health Gap Action Programme (mhGAP) intervention guidelines delivered by health care professionals with a good understanding of mental health care for older adults.

Manage age-associated conditions such as urinary incontinence

  • Prompted voiding for the management of urinary incontinence can be offered for older people with cognitive impairment
  • Pelvic floor muscle training, alone or combined with bladder control strategies and self-monitoring, should be recommended for older women with urinary incontinence (urge, stress or mixed)

Prevent falls

  • Medication review and withdrawal (of unnecessary or harmful medication) can be recommended for older people at risk of falls
  • Multimodal exercise (balance, strength, exibility and functional training) should be recommended for older people at risk of falls
  • Action on hazards – following a specialist’s assessment, home modi cations to remove environmental hazards that could cause falls should be recommended for older people at risk of falls
  • Multifactorial interventions integrating assessment with individually tailored interventions can be recommended to reduce the risk and incidence of falls among older people

Support caregivers

  • Psychological intervention, training and support should be offered to family members and other informal caregivers of care-dependent older people, particularly but not exclusively when the need for care is complex and extensive and/or there is signi cant caregiver strain

Implementation

Chapters within the guideline also consider the implementation of the recommendations and build upon established best practice of integrated care at the community level:

  • A comprehensive assessment and care plan shared with all providers
  • Person centric care plans based on shared decision making
  • Common care and treatment goals across different providers
  • Community outreach and home-based interventions
  • Support for self-management
  • Comprehensive referral and monitoring processes
  • Community engagement and caregiver support.

Publications

ICOPE Full Report

Access the full report below or at the WHO website.

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ICOPE Brochure

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World Report on Health and Ageing

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