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Cao X, Yi X, Chen H, Tian Y, Li S, Zhou J. Prevalence of intrinsic capacity decline among community-dwelling older adults: a systematic review and meta-analysis. Aging Clin Exp Res 2024; 36:157. [PMID: 39088112 PMCID: PMC11294388 DOI: 10.1007/s40520-024-02816-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 07/23/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND The concept of intrinsic capacity (IC) was introduced to define healthy aging and active aging based on functional capacity, yet there is limited understanding of the risk of IC decline at a population level. AIMS To consolidate existing evidence for rates of IC decline and risk factors among community-dwelling adults 60 years or older. METHODS According to the PRISMA guidelines, the literature search was independently conducted by two researchers in 8 databases from inception to January 2024 without language restrictions using combinations of free words and subject words. Qualities of included studies were assessed using Joanna Briggs Institute's (JBI's) critical appraisal checklist for prevalence studies. To pool the data, a random-effect meta-analysis was performed, followed by subgroup analysis and sensitivity analysis. All analyses were performed by Stata14.0. RESULTS From 1594 records, 15 studies were extracted with 33,070 participants for meta-analysis. The pooled prevalence of IC decline in community settings was 67.8% (95% CI: 57.0-78.5%; P < 0.001). The prevalence of IC decline in China (66.0%; 95% CI: 53.2-78.9%) was found to be slightly lower than in other countries/regions (73.0%; 95% CI: 59.8-86.3%); however, this difference was not statistically significant. Other subgroup analyses revealed no statistically significant differences in prevalence. Age, hypertension, diabetes, gender, education level, living status, smoking, regular exercise, marital status, and osteoarthritis are associated with IC decline. CONCLUSION More than two-thirds of older adults in the community are affected by IC decline, and age, hypertension, diabetes, female sex, low education level, living alone, smoking, irregular exercise, unmarried, and osteoarthritis are all risk factors for IC decline.
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Affiliation(s)
- Xia Cao
- Health Management Center, The Third Xiangya Hospital of Central South University, No. 138, Tongzipo Road, Changsha, 410013, China
| | - Xuanzi Yi
- Department of General Practice, The Third Xiangya Hospital of Central South University, No. 138, Tongzipo Road, Changsha, 410013, China
| | - Hui Chen
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410008, China
| | - Yusheng Tian
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410008, China
| | - Sihong Li
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410008, China
| | - Jiansong Zhou
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410008, China
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Tan F, Wei X, Zhang J, Zhao Y, Tong X, Michel JP, Shao R, Gong E. The assessment and detection rate of intrinsic capacity deficits among older adults: a systematic review and meta-analysis. BMC Geriatr 2024; 24:485. [PMID: 38831281 PMCID: PMC11149255 DOI: 10.1186/s12877-024-05088-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 05/17/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Assessing and monitoring intrinsic capacity (IC) is an effective strategy to promote healthy ageing by intervening early in high-risk populations. This review systematically analyzed the global detection rates of IC deficits and explored variations across diverse populations and data collection methods. METHODS This study was preregistered with PROSPERO, CRD42023477315. In this systematic review and meta-analysis, we systematically searched ten databases from January 2015 to October 2023, for peer-reviewed, observational studies or baseline survey of trials that assessed IC deficits among older adults aged 50 and above globally following the condition, context and population approach. The main outcome was intrinsic capacity deficits which could be assessed by any tools. Meta-analyses were performed by a random-effect model to pool the detection rates across studies and subgroup analyses were conducted by populations and data collection methods. RESULTS Fifty-six studies conducted in 13 countries were included in the review and 44 studies with detection rates of IC were included in the meta-analysis. The pooled detection rate of IC deficits was 72.0% (65.2%-78.8%) and deficits were most detected in sensory (49.3%), followed by locomotion (40.0%), cognition (33.1%), psychology (21.9%), and vitality (20.1%). Variations in detection rates of IC deficits were observed across studies, with higher rates observed in low- and middle-income countries (74.0%) and hyper-aged societies (85.0%). Study population and measurement tools also explained the high heterogeneity across studies. CONCLUSION IC deficits are common among older adults, while heterogeneity exists across populations and by measurement. Early monitoring with standardized tools and early intervention on specific subdomains of IC deficits are greatly needed for effective strategies to promote healthy ageing.
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Affiliation(s)
- Fangqin Tan
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, 31, Beijige 3 Aly, Dongcheng District, Beijing, China
| | - Xiaoxia Wei
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, 31, Beijige 3 Aly, Dongcheng District, Beijing, China
| | - Ji Zhang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, 31, Beijige 3 Aly, Dongcheng District, Beijing, China
| | - Yihao Zhao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, 31, Beijige 3 Aly, Dongcheng District, Beijing, China
| | - Xunliang Tong
- Department of Pulmonary and Critical Care Medicine, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jean-Pierre Michel
- University of Geneva, Geneva, Switzerland
- French Academy of Medicine, Paris, France
| | - Ruitai Shao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, 31, Beijige 3 Aly, Dongcheng District, Beijing, China.
- State Key Laboratory of Respiratory Health and Multimorbidity, Chinese Academy of Medical Sciences & Peking Union Medical College, 31, Beijige 3 Aly, Dongcheng District, Beijing, China.
| | - Enying Gong
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, 31, Beijige 3 Aly, Dongcheng District, Beijing, China.
- State Key Laboratory of Respiratory Health and Multimorbidity, Chinese Academy of Medical Sciences & Peking Union Medical College, 31, Beijige 3 Aly, Dongcheng District, Beijing, China.
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Rolland Y, Fielding R, Landi F, Vellas B. Implementing clinical operationalization of sarcopenia: the contribution of WHO ICOPE program. J Nutr Health Aging 2024; 28:100257. [PMID: 38714090 DOI: 10.1016/j.jnha.2024.100257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 04/25/2024] [Indexed: 05/09/2024]
Affiliation(s)
- Yves Rolland
- IHU HealthAge, CERPOP UMR 1295, CHU Toulouse, France.
| | - Roger Fielding
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA, USA
| | - Francesco Landi
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168 Rome, Italy
| | - Bruno Vellas
- IHU HealthAge, CERPOP UMR 1295, CHU Toulouse, France
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de Oliveira VP, Ferriolli E, Lourenço RA, González-Bautista E, de Souto Barreto P, de Mello RGB. 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. Maturitas 2023; 177:107818. [PMID: 37542782 DOI: 10.1016/j.maturitas.2023.107818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/26/2023] [Accepted: 07/27/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND 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. METHODS AND FINDINGS 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 50 years 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. CONCLUSION 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.
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Affiliation(s)
- Vitor Pelegrim de Oliveira
- Geriatric Unit - Internal Medicine Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, 5° andar, sala C 5006, Bloco C, Porto Alegre, RS CEP 90035-903, Brazil; Post Graduation Program in Medical Sciences: Endocrinology, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 2° andar, Porto Alegre, RS CEP 90035-000, Brazil; Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalier-Universitaire de Toulouse, 37 Allés Jules Guesdes, Toulouse, CP 31000, France.
| | - Eduardo Ferriolli
- Laboratório de Investigação Médica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo (USP), Av. Dr. Enéas de Carvalho Aguiar, 155, 8° andar, Bloco 8A, Setor Azul, São Paulo, SP CEP 05003-900, Brazil.
| | - Roberto Alves Lourenço
- Faculty of Health Sciences, Internal Medicine Department, Human Aging Research Laboratory, Universidade do Estado do Rio de Janeiro, Av. Mal. Rondon, 381, Rio de Janeiro, RJ CEP 20950-003, Brazil.
| | - Emmanuel González-Bautista
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalier-Universitaire de Toulouse, 37 Allés Jules Guesdes, Toulouse, CP 31000, France
| | - Philipe de Souto Barreto
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalier-Universitaire de Toulouse, 37 Allés Jules Guesdes, Toulouse, CP 31000, France
| | - Renato Gorga Bandeira de Mello
- Geriatric Unit - Internal Medicine Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, 5° andar, sala C 5006, Bloco C, Porto Alegre, RS CEP 90035-903, Brazil; Post Graduation Program in Medical Sciences: Endocrinology, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 2° andar, Porto Alegre, RS CEP 90035-000, Brazil.
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Gonzalez-Bautista E, Llibre-Guerra JJ, Sosa AL, Acosta I, Andrieu S, Acosta D, Llibre-Rodríguez JDJ, Prina M. Exploring the natural history of intrinsic capacity impairments: longitudinal patterns in the 10/66 study. Age Ageing 2023; 52:afad137. [PMID: 37517058 PMCID: PMC10387229 DOI: 10.1093/ageing/afad137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND intrinsic capacity (IC) is a construct encompassing people's physical and mental abilities. There is an implicit link amongst IC domains: cognition, locomotion, nutrition, sensory and psychological. However, little is known about the integration of the domains. OBJECTIVES to investigate patterns in the presentation and evolution of IC domain impairments in low-and-middle-income countries and if such patterns were associated with adverse outcomes. METHODS secondary analyses of the first two waves of the 10/66 study (population-based surveys conducted in eight urban and four rural catchment areas in Cuba, Dominican Republic, Puerto Rico, Venezuela, Peru, Mexico and China). We applied latent transition analysis on IC to find latent statuses (latent clusters) of IC domain impairments. We evaluated the longitudinal association of the latent statuses with the risk of frailty, disability and mortality, and tested concurrent and predictive validity. RESULTS amongst 14,923 participants included, the four latent statuses were: high IC (43%), low deterioration with impaired locomotion (17%), high deterioration without cognitive impairment (22%), and high deterioration with cognitive impairment (18%). A total of 61% of the participants worsened over time, 35% were stable, and 3% improved to a healthier status.Participants with deteriorated IC had a significantly higher risk of frailty, disability and dementia than people with high IC. There was strong concurrent and predictive validity. (Mortality Hazard Ratio = 4.60, 95%CI 4.16; 5.09; Harrel's C = 0.73 (95%CI 0.72;0.74)). CONCLUSIONS half of the study population had high IC at baseline, and most participants followed a worsening trend. Four qualitatively different IC statuses or statuses were characterised by low and high levels of deterioration associated with their risk of disability and frailty. Locomotion and cognition impairments showed other trends than psychological and nutrition domains across the latent statuses.
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Affiliation(s)
- Emmanuel Gonzalez-Bautista
- Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
- Institute on Aging, Toulouse University Hospital (CHU), Gerontopole, Toulouse, France
- Department of Health Service & Population Research, King’s College London, Institute of Psychiatry, Psychology &Neuroscience, London, UK
| | | | - Ana L Sosa
- National Institute of Neurology and Neurosurgery of Mexico, National Autonomous University of Mexico, Mexico City, Mexico
| | - Isaac Acosta
- Internal Medicine Department, Geriatric Section, Universidad Nacional Pedro Henriquez Ureña, Santo Domingo, Dominican Republic
| | - Sandrine Andrieu
- Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Daisy Acosta
- Internal Medicine Department, Geriatric Section, Universidad Nacional Pedro Henriquez Ureña, Santo Domingo, Dominican Republic
| | | | - Matthew Prina
- Department of Health Service & Population Research, King’s College London, Institute of Psychiatry, Psychology &Neuroscience, London, UK
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
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Tang WH, Yu TH, Lee HL, Lee YJ. Interactive effects of intrinsic capacity and obesity on the KDIGO chronic kidney disease risk classification in older patients with type 2 diabetes mellitus. Diabetol Metab Syndr 2023; 15:1. [PMID: 36588165 PMCID: PMC9806894 DOI: 10.1186/s13098-022-00975-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Intrinsic capacity (IC) is a novel concept focusing on normal and healthy aging. The effect of IC on the risk of chronic kidney disease (CKD) according to KDIGO category in older type 2 diabetes mellitus (T2DM) patients has rarely been studied. We investigated whether a decline in IC is associated with the risk of CKD according to KDIGO 2012 categories. METHODS This is a cross-sectional study. The exposure variables (IC score and body mass index) and outcome variable (KDIGO categories of the risk of CKD) were collected at the same timepoint. A total of 2482 older subjects with T2DM managed through a disease care program were enrolled. The five domains of IC, namely locomotion, cognition, vitality, sensory, and psychological capacity were assessed. Based on these domains, the IC composite score was calculated. CKD risk was classified according to the KDIGO 2012 CKD definition. Univariate and multivariate analyses were used to assess the association between IC score and KDIGO categories of risk of CKD. RESULTS The KDIGO CKD risk category increased in parallel with IC score (p for trend < 0.0001). In multivariate analysis, compared to those with an IC score 0, the odds ratio of having a KDIGO moderately increased to very high risk category of CKD was 1.76 (1.31-2.37) times higher for those with an IC score of 2-5. Furthermore, an increased IC score was associated with a higher prevalence of moderate and severe obesity. Moreover, there was a synergistic interaction between IC score and obesity on the KDIGO moderately increased to very high risk category of CKD (synergy index = 1.683; 95% CI 0.630-3.628), and the proportion of the KDIGO moderately increased to very high risk category of CKD caused by this interaction was 25.6% (attributable proportion of interaction = 0.256). CONCLUSIONS Our findings indicate that IC score may be closely related to the KDIGO moderately increased to very high risk category of CKD. In addition, there may be a synergistic interaction between IC score and obesity, and this synergistic interaction may increase the KDIGO CKD risk stage.
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Affiliation(s)
- Wei-Hua Tang
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Yuli Branch, Hualien, 98142 Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, 112304 Taiwan
| | - Teng-Hung Yu
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, 82445 Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, 82445 Taiwan
| | - Hui-Lan Lee
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, 10320 Taiwan
| | - Yau-Jiunn Lee
- Lee’s Endocrinologic Clinic, No. 130 Min-Tzu Rd, Pingtung, 90000 Taiwan
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Sum G, Lau LK, Jabbar KA, Lun P, George PP, Munro YL, Ding YY. The World Health Organization (WHO) Integrated Care for Older People (ICOPE) Framework: A Narrative Review on Its Adoption Worldwide and Lessons Learnt. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:154. [PMID: 36612480 PMCID: PMC9819593 DOI: 10.3390/ijerph20010154] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/06/2022] [Accepted: 12/17/2022] [Indexed: 06/17/2023]
Abstract
The World Health Organization (WHO) recently published guidelines on the implementation of a new Integrated Care for Older People (ICOPE) framework in 2017-2019. It is an integrated care framework for the screening, assessment, and management of intrinsic capacity (IC) declines. We aimed to examine where the early adopters of ICOPE are across the world, how these study teams and sites plan to apply the framework or have applied it, and the lessons learnt for future adopters. We systematically searched electronic medical and social sciences databases and grey literature published between 31 October 2017 and 31 March 2022. Records were systematically selected using precise inclusion criteria. There were 18 ICOPE study teams and sites across the 29 selected records. Of the 18 study teams and sites, seven were in the development stage, seven conducted feasibility studies, and four have commenced implementation of interventions that applied the ICOPE framework. Future ICOPE adopters may need to make certain decisions. These include whether to adopt ICOPE in the community setting or other settings, whether to adopt only Step 1 on IC screening or additional ICOPE Steps, whether the ICOPE IC screening tool requires modifications, and whether to use digital health technology. We propose the key factors needed to make these decisions and future research needed.
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Affiliation(s)
- Grace Sum
- Geriatric Education and Research Institute, Singapore 768024, Singapore
| | - Lay Khoon Lau
- Geriatric Education and Research Institute, Singapore 768024, Singapore
| | | | - Penny Lun
- Geriatric Education and Research Institute, Singapore 768024, Singapore
| | - Pradeep Paul George
- Geriatric Education and Research Institute, Singapore 768024, Singapore
- National Healthcare Group, Health Services and Outcomes Research, Singapore 138543, Singapore
| | - Yasmin Lynda Munro
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Yew Yoong Ding
- Geriatric Education and Research Institute, Singapore 768024, Singapore
- Department of Geriatric Medicine & Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore 308433, Singapore
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Tavassoli N, de Souto Barreto P, Berbon C, Mathieu C, de Kerimel J, Lafont C, Takeda C, Carrie I, Piau A, Jouffrey T, Andrieu S, Nourhashemi F, Beard JR, Soto Martin ME, Vellas B. Implementation of the WHO integrated care for older people (ICOPE) programme in clinical practice: a prospective study. THE LANCET. HEALTHY LONGEVITY 2022; 3:e394-e404. [PMID: 36098317 DOI: 10.1016/s2666-7568(22)00097-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The INSPIRE integrated care for older people (ICOPE)-CARE programme is a public health programme implementing the ICOPE health-care pathway in clinical practice. The primary objective of this study was to describe the large-scale implementation and feasibility of the INSPIRE ICOPE-CARE guidelines in clinical practice. The secondary aims were to describe the characteristics of patients who were identified as positive for abnormalities in intrinsic capacity (ie, locomotion, cognition, psychology, vitality, hearing, and vision) during step 1, and to describe the prevalence of these positive screenings. METHODS In this prospective study, we evaluated a real-life population of users of primary care services in the Occitania region (France). Participants who were aged 60 years and older and lived in a community were eligible for inclusion in our study. Individuals aged ≥60 years were screened (step 1) by health-care providers or through self-assessments using digital tools (the ICOPE MONITOR app and the ICOPEBOT conversational robot). Our implementation strategy involved raising awareness among health-care professionals about the WHO ICOPE programme, training professionals in the ICOPE-CARE guidelines, and developing a digital infrastructure (ie, digital tools, a database, and a remote ICOPE monitoring platform). The feasibility of implementing the INSPIRE ICOPE-CARE guidelines was determined by the anticipated inclusion of ≥10 000 participants, and having a follow-up rate of over 50%. FINDINGS Between Jan 1, 2020, and November 18, 2021, 10 903 older people (mean age 76·0, SD 10·5 years; 6627 [60·8%] of whom were women) had a baseline step 1 screening done, and 5185 (70·4%) of 7367 eligible participants had a 6-month follow-up of step 1 screening. 10 285 (94·3%) participants had a positive intrinsic capacity result during screening at baseline. 958 (9·3%) participants were evaluated with step 2 (in-depth assessments). Positive intrinsic capacity was confirmed in 865 (90·3%) participants. Most recommendations in step 3 (care plan) were related to locomotion, vitality, and cognition. INTERPRETATION The high number of participants included in our study, as well as the high rates of follow-up, provides evidence to suggest that the large-scale implementation of ICOPE in clinical practice is feasible. The very high prevalence of positive screening for impaired intrinsic capacity during step 1, as well as the high rates of confirmed deficits in intrinsic capacity during step 2, suggest that the INSPIRE ICOPE-CARE programme is able to target individuals who are at increased risk for functional loss and disability. FUNDING Occitania Regional Health Agency, Region Occitanie and Pyrénées-Méditerranée, European Regional Development Fund, and The Interreg Program V-A Spain-France-Andorra.
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Affiliation(s)
- Neda Tavassoli
- Gerontopole, Toulouse University Hospital, WHO Collaborating Center for Frailty, Clinical and Geroscience Research, and Geriatric Training, Toulouse, France.
| | - Philipe de Souto Barreto
- Gerontopole, Toulouse University Hospital, WHO Collaborating Center for Frailty, Clinical and Geroscience Research, and Geriatric Training, Toulouse, France; Maintain Aging Research team, Centre d'Epidémiologie et de Recherche en santé des POPulations, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Caroline Berbon
- Gerontopole, Toulouse University Hospital, WHO Collaborating Center for Frailty, Clinical and Geroscience Research, and Geriatric Training, Toulouse, France
| | - Celine Mathieu
- Gerontopole, Toulouse University Hospital, WHO Collaborating Center for Frailty, Clinical and Geroscience Research, and Geriatric Training, Toulouse, France
| | - Justine de Kerimel
- Gerontopole, Toulouse University Hospital, WHO Collaborating Center for Frailty, Clinical and Geroscience Research, and Geriatric Training, Toulouse, France
| | - Christine Lafont
- Gerontopole, Toulouse University Hospital, WHO Collaborating Center for Frailty, Clinical and Geroscience Research, and Geriatric Training, Toulouse, France
| | - Catherine Takeda
- Gerontopole, Toulouse University Hospital, WHO Collaborating Center for Frailty, Clinical and Geroscience Research, and Geriatric Training, Toulouse, France
| | - Isabelle Carrie
- Gerontopole, Toulouse University Hospital, WHO Collaborating Center for Frailty, Clinical and Geroscience Research, and Geriatric Training, Toulouse, France
| | - Antoine Piau
- Gerontopole, Toulouse University Hospital, WHO Collaborating Center for Frailty, Clinical and Geroscience Research, and Geriatric Training, Toulouse, France; Maintain Aging Research team, Centre d'Epidémiologie et de Recherche en santé des POPulations, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Tania Jouffrey
- Gerontopole, Toulouse University Hospital, WHO Collaborating Center for Frailty, Clinical and Geroscience Research, and Geriatric Training, Toulouse, France
| | - Sandrine Andrieu
- Gerontopole, Toulouse University Hospital, WHO Collaborating Center for Frailty, Clinical and Geroscience Research, and Geriatric Training, Toulouse, France; Maintain Aging Research team, Centre d'Epidémiologie et de Recherche en santé des POPulations, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France; Clinical Epidemiology and Public Health Department, Toulouse University Hospital, Toulouse, France
| | - Fatemeh Nourhashemi
- Gerontopole, Toulouse University Hospital, WHO Collaborating Center for Frailty, Clinical and Geroscience Research, and Geriatric Training, Toulouse, France; Maintain Aging Research team, Centre d'Epidémiologie et de Recherche en santé des POPulations, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - John R Beard
- Australian Research Council Centre of Excellence in Population Ageing Research, University of New South Wales, Sydney, NSW, Australia
| | - Maria Eugenia Soto Martin
- Gerontopole, Toulouse University Hospital, WHO Collaborating Center for Frailty, Clinical and Geroscience Research, and Geriatric Training, Toulouse, France; Maintain Aging Research team, Centre d'Epidémiologie et de Recherche en santé des POPulations, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Bruno Vellas
- Gerontopole, Toulouse University Hospital, WHO Collaborating Center for Frailty, Clinical and Geroscience Research, and Geriatric Training, Toulouse, France; Maintain Aging Research team, Centre d'Epidémiologie et de Recherche en santé des POPulations, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
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Sum G, Nicholas SO, Nai ZL, Ding YY, Tan WS. Health outcomes and implementation barriers and facilitators of comprehensive geriatric assessment in community settings: a systematic integrative review [PROSPERO registration no.: CRD42021229953]. BMC Geriatr 2022; 22:379. [PMID: 35488198 PMCID: PMC9052611 DOI: 10.1186/s12877-022-03024-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 03/29/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Comprehensive geriatric assessment (CGA) addresses the bio-psycho-social needs of older adults through multidimensional assessments and management. Synthesising evidence on quantitative health outcomes and implementation barriers and facilitators would inform practice and policy on CGA for community-dwelling older adults. METHODS We systematically searched four medical and social sciences electronic databases for quantitative, qualitative, and mixed methods studies published from 1 January 2000 to 31 October 2020. Due to heterogeneity of articles, we narratively reviewed the synthesis of evidence on health outcomes and implementation barriers and facilitators. RESULTS We screened 14,151 titles and abstracts and 203 full text articles, and included 43 selected articles. Study designs included controlled intervention studies (n = 31), pre-post studies without controls (n = 4), case-control (n = 1), qualitative methods (n = 3), and mixed methods (n = 4). A majority of articles studied populations aged ≥75 years (n = 18, 42%). CGAs were most frequently conducted in the home (n = 25, 58%) and primary care settings (n = 8, 19%). CGAs were conducted by nurses in most studies (n = 22, 51%). There was evidence of improved functional status (5 of 19 RCTs, 2 of 3 pre-post), frailty and fall outcomes (3 of 6 RCTs, 1 of 1 pre-post), mental health outcomes (3 of 6 RCTs, 2 of 2 pre-post), self-rated health (1 of 6 RCTs, 1 of 1 pre-post), and quality of life (4 of 17 RCTs, 3 of 3 pre-post). Barriers to implementation of CGAs involved a lack of partnership alignment and feedback, poor acceptance of preventive work, and challenges faced by providers in operationalising and optimising CGAs. The perceived benefits of CGA that served to facilitate its implementation included the use of highly skilled staff to provide holistic assessments and patient education, and the resultant improvements in care coordination and convenience to the patients, particularly where home-based assessments and management were performed. CONCLUSION There is mixed evidence on the quantitative health outcomes of CGA on community-dwelling older adults. While there is perceived positive value from CGA when carried out by highly skilled staff, barriers such as bringing providers into a partnership, greater acceptance of preventive care, and operational issues could impede its implementation.
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Affiliation(s)
- Grace Sum
- Geriatric Education and Research Institute, Singapore, Singapore.
| | | | - Ze Ling Nai
- Geriatric Education and Research Institute, Singapore, Singapore
| | - Yew Yoong Ding
- Geriatric Education and Research Institute, Singapore, Singapore
- Department of Geriatric Medicine, Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital, Singapore, Singapore
| | - Woan Shin Tan
- Geriatric Education and Research Institute, Singapore, Singapore
- Health Services and Outcomes Research Department, National Healthcare Group, Singapore, Singapore
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Dinakrisma AA, Laksmi PW, Abdiel T, Fernandez JP, Indahwati N, Susanto AP, Indrajaya Lukmana AA, Yusuf PA. The role of digital mobile technology in elderly health management among health care workers in Indonesia: Analysis of knowledge, attitudes, and practice. Digit Health 2022; 8:20552076221102771. [PMID: 35646377 PMCID: PMC9131384 DOI: 10.1177/20552076221102771] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 05/08/2022] [Indexed: 11/15/2022] Open
Abstract
Background Technology, including information and communication technology (ICT), plays a significant role in the quality of health services. However, its application in elderly health services is still lacking. The aim of this study was to determine the knowledge of, attitudes toward, and practices of cell phone and mobile application use for elderly health care among Indonesian health care workers. Methods This was a cross-sectional study conducted with health care workers in Jakarta, Indonesia. The potential subjects were contacted through instant messenger application and/or through conventional short message service or telephone calls from August through November 2020. Results There were 134 subjects. All the subjects had used various health applications to assist with their daily work, including telemedicine (64.2%), guidelines (60.4%), and medical calculators (46.3%). However, 96.3% of the subjects were not aware of the existence of a health application for geriatric assessment. Furthermore, 98.5% of subjects thought that it is important to use ICT to manage geriatric patients, and 94.8% felt that comprehensive geriatric assessment (CGA) in digital form would help them manage geriatric patients better. Nevertheless, 35.10% of subjects had never applied CGA to their geriatric patients. Conclusions The current health care system has begun to enter a period of using ICT in performing health services for geriatric patients. Nevertheless, only a few Indonesian health care workers were aware of or were using the geriatric mobile application. It is essential to improve the dissemination of geriatric health care and e-health literacy among them to improve the quality of elderly health care.
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Affiliation(s)
- Anastasia A. Dinakrisma
- Geriatric Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia/Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Purwita Wijaya Laksmi
- Geriatric Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia/Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Teofilus Abdiel
- Geriatric Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia/Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Johannes P. Fernandez
- Geriatric Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia/Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Nuri Indahwati
- Geriatric Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia/Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Anindya Pradipta Susanto
- Department of Medical Physics, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Medical Technology Cluster, Indonesian Medical Education and Research Institute (IMERI), Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | | | - Prasandhya Astagiri Yusuf
- Department of Medical Physics, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Medical Technology Cluster, Indonesian Medical Education and Research Institute (IMERI), Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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