WHO framework, focused on screening for physical and mental wellness for personalised care, offers promise for healthy ageing: Study

RESEARCH HIGHLIGHT

The use of mobile apps for self-screening and other learning points are discussed in GERI’s global study on the application of the WHO Integrated Care for Older People (ICOPE) framework—which is gaining relevance for countries with action plans to address ageing, like Singapore.

To unlock not just longer but healthier lives, it is crucial to prevent, slow or reverse declines in older adults' physical and mental capacities, or their intrinsic capacity. With good cognitive function, mobility and mental well-being – some of the domains of intrinsic capacity – seniors can age healthily. Recognising this, the World Health Organization (WHO) progressively introduced the Integrated Care for Older People (ICOPE) framework from 2017 to 2019. The ICOPE framework aims to prevent and manage declines in intrinsic capacity among older people by optimising how healthcare and social services are provided to them.

In order to understand how the WHO ICOPE framework has been applied thus far, researchers from the Geriatric Education and Research Institute (GERI) systematically reviewed medical and social sciences research published between October 2017 and March 2022, examining 18 study teams from around the world. Published in the International Journal of Environmental Research and Public Health, GERI's first-of-its-kind study indicates that the ICOPE framework offers a viable approach to enable healthy ageing. The study also provides key lessons learnt for policymakers and practitioners to consider in adopting this relatively new framework.

"For older persons to live and age well, a holistic view on health and well-being is needed. The concept of intrinsic capacity is very relevant for healthy ageing as it accounts for the physical, psychological, nutritional and functional health and wellness of seniors," said Dr Grace Sum Chi-En, Research Fellow at GERI. Dr Sum is the Principal Investigator and lead author of the study.

"Intrinsic capacity is the focus of the WHO ICOPE framework. It guides doctors, healthcare workers and policymakers on how to screen for intrinsic capacity, and provide personalised and coordinated care based on each individual's unique healthcare and social needs. Given the ICOPE framework's growing recognition globally and in Singapore, GERI's study on where and how it has been applied provides timely guidance to pave the way for adoption," said Associate Professor Ding Yew Yoong, Executive Director of GERI and senior author of the study.

Key findings and lessons learnt

Majority of the 18 study teams and study sites that have applied the WHO ICOPE framework were in Europe and China, with those in France and China having recently implemented large-scale programmes for older people in the community. At the time of GERI's study, study teams from Asia that have adopted the framework were in China, Hong Kong, India, South Korea and Taiwan.

Overall, evidence from the study teams point to the applicability of the WHO ICOPE framework to different types of healthcare systems, its ease of use and its potential benefits towards living well for ageing populations. GERI researchers reported the following lessons learnt for practitioners and health policymakers when adopting the ICOPE framework:

1.         The WHO ICOPE framework promotes the use of digital health technology

The WHO ICOPE framework consists of five steps. The authors reported that at least five of the 18 study teams that adopted the ICOPE framework used mobile apps to carry out Step 1, which involves screening for the domains of intrinsic capacity like cognitive function, mobility, psychological well-being, vitality, sight and hearing. Step 1 can be done via self-screening using a mobile app such as the WHO ICOPE Handbook app, or in a healthcare setting.

"Our study suggests that digital health technology is a convenient way for people to track their health and encourages them to take charge of their own well-being. The technology also enables the detection and long-term monitoring of intrinsic capacity of older people in large-scale health programmes in the community," said Dr Sum. This technology includes mobile apps and chat-bots for regular self-screening and telemedicine databases that allow healthcare staff to monitor the health of patients and coordinate personalised care for them.

"We found that older persons may face challenges in self-screening when they do not have or know how to use mobile devices. For this group, family members and caregivers could assist them, or they could be screened at community centres and primary care clinics," added Dr Sum.

2.         Partial adoption of the five-step WHO ICOPE framework could still reap benefits

All 18 study teams were found to have applied at least Step 1 of the WHO ICOPE framework, which screens for declines in intrinsic capacity. Steps 2 and 3 involve comprehensive assessment in primary care and development of personalised care plans. Healthcare professionals take into consideration the older person's personal preferences, needs and environments. Step 4 is the referral to specialists and Step 5 involves supporting older persons and their caregivers within their communities.

"Future adopters that have health systems with existing care processes, such as Comprehensive Geriatric Assessment and elements of integrated care that are similar to Steps 2 to 5 of the WHO ICOPE framework, could adopt Step 1 only. In this way, the helpful functions of the ICOPE framework are integrated into health systems without the need to undergo a major redesign of the community care ecosystem for older persons. Importantly, Step 1 can represent the 'front door' of care processes for targeted health assessment of older persons in the community," Associate Professor Ding said.

3.         Screening questions to assess intrinsic capacity modified to suit different contexts

The WHO ICOPE framework proposes questions and tests used to screen for intrinsic capacity declines. The authors found that the questions and tests were altered by adopters according to the needs of their local contexts and cultures, and available resources. For example, questions were amended to suit the local dialect. Some older persons are unable to do the seeing and hearing tests using the mobile app, so they instead they could indicate in the app their ability to see and hear in daily life.

4.         Flexibility in applying the WHO ICOPE framework to different target groups of older adults

GERI's study found that existing adopters of the WHO ICOPE framework had the flexibility to apply it to different target groups. For programmes targeting older patients who visit their general practitioner, they would apply Step 1 of screening for intrinsic capacity declines only in primary care settings. For programmes that aim to detect decreases in intrinsic capacity in the general older adult population, infrastructure would be needed to target a larger group of people.

5.         Feasibility of the WHO ICOPE framework can be tested prior to larger-scale implementation

The study reported that seven of the 18 study teams were in the process of testing the feasibility of the WHO ICOPE framework in a smaller scale, prior to implementing it on a larger population of older people. This process would allow healthcare teams and researchers to better understand how to utilise this framework, address challenges faced and tailor the screening and care services to their specific target groups, prior to a larger-scale rollout of the programme.

"With Singapore embarking on HealthierSG which promotes the well-being and health of our population, the ICOPE framework offers an attractive option for supporting preventive health among older persons through the early identification of deficits in key physical and mental capacities. It provides care pathways for those who would benefit from individualised assessment and actions that in turn work towards the maintenance of functional ability, which is so important to older persons," said Associate Professor Ding.

"Over the next few years, we expect to have a better understanding on the ICOPE framework's longer-term impact on achieving healthy ageing among older adults. Further research will inform us on the resources and infrastructure needed to sustain this model of care, and the factors that hinder and enable implementation," shared Dr Sum.

The full study can be accessed here and the related GERI Research Brief can be read here [PDF, 621 KB]. 

Reference:  Sum, G.; Lau, L.K.; Jabbar, K.A.; Lun, P.; George, P.P.; Munro, Y.L.; Ding, Y.Y. "The World Health Organization (WHO) Integrated Care for Older People (ICOPE) Framework: A Narrative Review on Its Adoption Worldwide and Lessons Learnt." Int. J. Environ. Res. Public Health 2023, 20, 154.