Identification of decreased intrinsic capacity: Performance of diagnostic measures of the ICOPE Screening tool in community dwelling older people in the VIMCI study

Abstract

Background The World Health Organization (WHO) has developed the Integrated Care for Older People (ICOPE) strategy to face the challenges of ageing societies. This strategy is focused on person centered care and the assessment intrinsic capacity (IC). Early identification of five domains of IC (cognition, locomotion, vitality, sensory (hearing and vision), and psychological) has been shown to be related with adverse outcomes and can guide actions towards primary prevention and healthy ageing. IC assessment proposed by the WHO ICOPE guidelines is composed by two steps: First, Screening for decreased IC by the ICOPE Screening tool; second, by the reference standard methods. The aim was to assess the performance of diagnostic measures (sensibility, specificity, diagnostic accuracy, and agreement of the ICOPE Screening tool) compared to the reference standard methods in European community-dwelling older adults. Methods Cross-sectional analysis of the baseline of the ongoing VIMCI (Validity of an Instrument to Measure Intrinsic Capacity) cohort study, which was carried out in Primary Care centers and outpatient clinics from 5 rural and urban territories in Catalonia (Spain). Participants were 207community dwelling persons ≥ 70-year-old with Barthel $$\ge$$ ≥ 90, without dementia or advanced chronic conditions who provided their consent to participate. The 5 IC domains were assessed by the ICOPE Screening tool and the reference methods (SPPB, gait speed, MNA, Snellen chart, audiometry, MMSE, GDS5) during patients’ visit. Agreement was assessed with the Gwet AC1 index. Results ICOPE Screening tool sensitivity was higher for cognition (0.889) and ranged between 0.438 and 0.569 for most domains. Specificity ranged from 0.682 to 0.96, diagnostic accuracy from 0.627 to 0.879, Youden index from 0.12 to 0.619, and Gwet AC1 from 0.275 to 0.842. Conclusion The ICOPE screening tool showed fair performance of diagnostic measures; it was helpful to identify those participants with satisfactory IC and showed a modest ability to identify decreased IC in older people with high degree of autonomy. Since low sensitivities were found, a process of external validation would be recommended to reach better discrimination. Further studies about the ICOPE Screening tool and its performance of diagnostic measures in different populations are urgently required.

A simple scoring algorithm based on intrinsic capacity for functional ability in community-dwelling older adults in Taiwan

“…Among the seven IC-related components, six predictors expect vision capacity were identified to be significantly associated with the functional abilities in varied contribution. The results are consistent with a study assessing the performance of diagnostic measures of the ICOPE screening tool in European community-dwelling older adults, which showed only vision, but not other IC-related domains vision, had the lowest sensitivity among all IC domains between normal and altered population [ 46 ]. Among all IC predictors in the scoring algorithm, locomotion weighted most in predicting IADL and frailty.…”

Intrinsic capacity assessment using World Health Organization Integrated Care for Older People Step 1, and the association with frailty in community dwelling older adults

“…Studies that used the Step 1 screen as designed reported lower prevalence rates of cognitive loss (e.g. 20.3% in Taiwan, 37 24.3% in Hong Kong 38 and 31% in Spain 39 ) compared with studies that estimated cognitive loss based on the Step 1 screen derived from MMSE (e.g. 52.2% in France 40 ).…”

Diagnostic performance analysis of the Integrated Care for Older People (ICOPE) screening tool for identifying decline in intrinsic capacity

“…A study in Spain [ 12 ] enrolled 207 older people aged ≥ 70 years, based on the WHO IC assessment pathway, including screening and detailed evaluation of vision and hearing. The results revealed that among all dimensions, the cognitive domain had the highest sensitivity (0.889), with the other dimensions ranging from 0.438–0.557.…”

“…However, what is the diagnostic performance of the ICOPE screening tool in detecting IC decline? There are two published studies, one from Hong Kong, China [ 11 ], and the other from Spain [ 12 ]; both of them indicate that the ICOPE screening tool has high sensitivity but varying screening effectiveness across different dimensions. Additionally, no relevant studies have been conducted in mainland China.…”