Intrinsic capacity as a framework for Integrated Care for Older People (ICOPE); insights from the 10/66 Dementia Research Group cohort studies in Latin America, India and China

Abstract

Background The World Health Organization has reframed health and healthcare for older people around achieving the goal of healthy ageing. Recent evidence-based guidelines on Integrated Care for Older People focus on maintaining intrinsic capacity, addressing declines in mobility, nutrition, vision and hearing, cognition, mood and continence aiming to prevent or delay the onset of care dependence. The target group (with one or more declines in intrinsic capacity) is broad, and implementation at scale may be challenging in less-resourced settings. Planning can be informed by assessing the prevalence of intrinsic capacity, characterising the target group, and validating the general approach by evaluating risk prediction for incident dependence and mortality. Methods Population-based cohort studies in urban sites in Cuba, Dominican Republic, Puerto Rico, Venezuela, and rural and urban sites in Peru, Mexico, India and China. Sociodemographic, behaviour and lifestyle, health, healthcare utilisation and cost questionnaires, and physical assessments were administered to all participants, with ascertainment of incident dependence, and mortality, three to five years later. Results In the 12 sites in eight countries, 17,031 participants were surveyed at baseline. Intrinsic capacity was least likely to be retained for locomotion (71.2%), vision (71.3%), cognition (73.5%), and mood (74.1%). Only 30% retained full capacity across all domains, varying between one quarter and two-fifths in most sites. The proportion retaining capacity fell sharply with increasing age, and declines affecting multiple domains were more common. Poverty, morbidity (particularly dementia, depression and stroke), and disability were concentrated among those with DIC, although only 10% were frail, and a further 9% had needs for care. Hypertension and lifestyle risk factors for chronic disease, healthcare utilization and costs were more evenly distributed in the general older population. 15,901 participants were included in the mortality cohort (2,602 deaths/ 53,911 person years of follow-up), and 12,965 participants in the dependence cohort (1900 incident cases/ 38,377 person-years). DIC (any decline, and number of domains affected) strongly and independently predicted incident dependence and death. Relative risks were higher for those who were frail, but were also substantially elevated for the much larger sub-groups yet to become frail. Mortality was mainly concentrated in the frail and dependent sub-groups. Conclusions Our findings support the strategy to focus on optimizing intrinsic capacity in pursuit of healthy ageing. Most needs for care arise in those with declines in intrinsic capacity who are yet to become frail. Implementation at scale requires community-based screening and assessment, and a stepped-care approach to intervention. Community healthcare workers roles would need redefinition to engage, train and support them in these tasks. ICOPE could be usefully integrated into community programmes orientated to the detection and case management of chronic diseases including hypertension and diabetes.

Development and Validation of an Intrinsic Capacity Score in the UK Biobank Study

“…Those participants with lower baseline IC had a higher incident co-morbidity. This finding agrees with evidence from other studies which depict inverse cross-sectional and longitudinal associations between IC and multimorbidity [3,8,29,36,39,50,56,59]. The relationship with incident CCI is consistent with the "geroscience hypothesis" that age related biological changes increase the risk of most chronic diseases chronic diseases [65].…”

“…Since the introduction of IC, extensive research has been conducted to measure and validate this construct, as well as to assess its relevance in medical, social, and behavioral sciences [3-5, [7][8][9].…”

“…their opportunity to do and be what they value. The concept has now found use in medicine, health, social, and behavioral science as a lens through which to anticipate and understand human behavior in all its manifestations [3][4][5][6][7][8][9].…”

How Many People Live with Dementia in Portugal? A Discussion Paper of National Estimates

“…We could benefit from drawing on recent Integrated Care for Older People (ICOPE) guidelines for the management of decline in intrinsic capacity [59]; these recommendations address decline not only in cognition, but also in mobility, nutrition, vision and hearing, and mood and continence, aiming to prevent or delay the onset of care dependence and promote healthy ageing. Research, including by the 10/66 DRG, supports this framework [60].…”

A Study of Knowledge on Alzheimer's Disease and Attitudes of Chinese Social Residents towards Alzheimer’s disease: a cross-sectional survey in China

“…20 million AD patients are expected by 2050. China's AD population is the largest and growing fastest [3][4][5] . In China, 5% of 65-year-olds, 11.5% of 75-year-olds, and 30% of 85-year-olds have dementia.…”