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Real-life intrinsic capacity screening data from the ICOPE-Care program

Nature Aging volume 4, pages 1279–1289 (2024)Cite this article

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Abstract

The Integrated Care for Older People (ICOPE) program is a healthcare pathway that uses a screening test for intrinsic capacity (IC) as its entry point. However, real-life data informing on how IC domains cluster and change over time, as well as their clinical utility, are lacking. Using primary healthcare screening data from more than 20,000 French adults 60 years of age or older, this study identified four clusters of IC impairment: ‘Low impairment’ (most prevalent), ‘Cognition+Locomotion+Hearing+Vision’, ‘All IC impaired’ and ‘Psychology+Vitality+Vision’. Compared to individuals with ‘Low impairment’, those in the other clusters had higher likelihood of having frailty and limitations in both activities of daily living (ADL) and instrumental activities of daily living (IADL), with the strongest associations being observed for ‘All IC impaired’. This study found that ICOPE screening might be a useful tool for patient risk stratification in clinical practice, with a higher number of IC domains impaired at screening indicating a higher probability of functional decline.

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Fig. 1: Age-adjusted and sex-adjusted conditional probabilities for the transition of IC clusters between baseline and follow-up.

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Data availability

The data reported in this paper (text, tables, figures and the supplementary material) will be shared in de-identified form owing to privacy protections. Requests for de-identified data and a data dictionary will be evaluated by the ICOPE-Care data-sharing committee, which can be contacted at the following address: tavassoli.n@chu-toulouse.fr. Data will be made available for investigators upon request for a pre-identified scientific purpose developed in a research proposal with sound methodology, subject to the approval of the appropriate ICOPE-Care committee; a data use agreement must also be signed. Given the nature of the ICOPE-Care program (ongoing, real-life data from healthcare services), the authors are unable to make the dataset publicly accessible at this time. In addition, according to the ICOPE-Care policy, all analyses using ICOPE-Care data (including the present study) must be evaluated and approved by the committee after submission of a comprehensive analysis proposal. Therefore, for researchers interested in accessing the data used for the current study, the same evaluation procedure must be followed.

Code availability

The codes supporting the findings of this study are available upon reasonable request from the corresponding author. All analyses were performed using programming languages in the Stata software package.

References

  1. World Health Organization. Integrated care for older people: guidelines on community-level interventions to manage declines in intrinsic capacity. https://iris.who.int/handle/10665/258981 (2017).

  2. World Health Organization. World report on ageing and health. https://iris.who.int/handle/10665/186463 (2015).

  3. World Health Organization. Integrated care for older people (ICOPE): guidance on person-centred assessment and pathways in primary care. https://www.who.int/publications/i/item/WHO-FWC-ALC-19.1 (2019).

  4. Thiyagarajan, J. A. et al. Redesigning care for older people to preserve physical and mental capacity: WHO guidelines on community-level interventions in integrated care. PLoS Med. 16, e1002948 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  5. Beard, J. R., Si, Y., Liu, Z., Chenoweth, L. & Hanewald, K. Intrinsic capacity: validation of a new WHO concept for healthy aging in a longitudinal chinese study. J. Gerontol. A Biol. Sci. Med. Sci. 77, 94–100 (2022).

    Article  PubMed  Google Scholar 

  6. Beard, J. R., Jotheeswaran, A. T., Cesari, M. & Araujo de Carvalho, I. The structure and predictive value of intrinsic capacity in a longitudinal study of ageing. BMJ Open 9, e026119 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  7. Yu, R. et al. Validation of the construct of intrinsic capacity in a longitudinal chinese cohort. J. Nutr. Health Aging 25, 808–815 (2021).

    Article  PubMed  CAS  Google Scholar 

  8. Sum, G. et al. 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 20, 154 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  9. de Oliveira, V. P. et al. 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 177, 107818 (2023).

    Article  PubMed  Google Scholar 

  10. Tavassoli, N. et al. Implementation of the WHO integrated care for older people (ICOPE) programme in clinical practice: a prospective study. Lancet Healthy Longev. 3, e394–e404 (2022).

    Article  PubMed  Google Scholar 

  11. Tavassoli, N. et al. Framework implementation of the INSPIRE ICOPE-CARE program in collaboration with the World Health Organization (WHO) in the Occitania Region. J. Frailty Aging 10, 103–109 (2021).

    PubMed  CAS  Google Scholar 

  12. Soler, V. et al. Visual impairment screening at the geriatric frailty clinic for assessment of frailty and prevention of disability at the gérontopôle. J. Nutr. Health Aging 20, 870–877 (2016).

    Article  PubMed  CAS  Google Scholar 

  13. Luo, Y. et al. Trends in the prevalence of vision impairment among the oldest-old Chinese population from 1998 to 2018. J. Glob. Health 12, 11006 (2022).

    Article  PubMed  Google Scholar 

  14. Zheng, D. D. et al. Longitudinal associations between visual impairment and cognitive functioning: the Salisbury Eye Evaluation Study. JAMA Ophthalmol. 136, 989–995 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  15. Kolli, A. et al. Midlife vision impairment and cognitive function in later life: the study of women’s health across the nation, Michigan cohort. J. Gerontol. A Biol. Sci. Med. Sci. 76, 2178–2186 (2021).

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  16. Kee, Q. T. et al. The impact of near visual impairment on instrumental activities of daily living among community-dwelling older adults in Selangor. BMC Res. Notes 14, 395 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  17. Christ, S. L. et al. Longitudinal relationships among visual acuity, daily functional status and mortality: the Salisbury Eye Evaluation Study. JAMA Ophthalmol. 132, 1400–1406 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lam, B. L. et al. Longitudinal relationships among visual acuity and tasks of everyday life: the Salisbury Eye Evaluation Study. Invest. Ophthalmol. Vis. Sci. 54, 193–200 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  19. Gonzales-Turín, J. M., Rodríguez-Laso, Á., Carnicero, J. A., García-García, F. J. & Rodríguez-Mañas, L. Relationship between self-reported visual impairment and worsening frailty transition states in older people: a longitudinal study. Aging Clin. Exp. Res. 33, 2491–2498 (2021).

    Article  PubMed  Google Scholar 

  20. Zheng, D. D. et al. Visual acuity and increased mortality: the role of allostatic load and functional status. Invest. Ophthalmol. Vis. Sci. 55, 5144–5150 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  21. Ehrlich, J. R. et al. Association between vision impairment and mortality: a systematic review and meta-analysis. Lancet Glob. Health 9, e418–e430 (2021).

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. Fricke, T. R. et al. Global prevalence of presbyopia and vision impairment from uncorrected presbyopia: systematic review, meta-analysis and modelling. Ophthalmology 125, 1492–1499 (2018).

    Article  PubMed  Google Scholar 

  23. Lee, W. J., Peng, L. N., Lin, M. H., Lin, C. H. & Chen, L. K. Clinical efficacy of multidomain interventions among multimorbid older people stratified by the status of physio-cognitive declines: a secondary analysis from the randomized controlled trial for healthy aging. J. Nutr. Health Aging 26, 909–917 (2022).

    Article  PubMed  Google Scholar 

  24. Buchman, A. S., Boyle, P. A., Leurgans, S. E., Barnes, L. L. & Bennett, D. A. Cognitive function is associated with the development of mobility impairments in community-dwelling elders. Am. J. Geriatr. Psychiatry 19, 571–580 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  25. Braun, T. et al. Association of clinical outcome assessments of mobility capacity and incident disability in community-dwelling older adults—a systematic review and meta-analysis. Ageing Res. Rev. 81, 101704 (2022).

    Article  PubMed  Google Scholar 

  26. van Grootven, B. & van Achterberg, T. Prediction models for functional status in community dwelling older adults: a systematic review. BMC Geriatr. 22, 465 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kelaiditi, E. et al. Cognitive frailty: rational and definition from an (I.A.N.A./I.A.G.G.) international consensus group. J. Nutr. Health Aging 17, 726–734 (2013).

    Article  PubMed  CAS  Google Scholar 

  28. Zhang, X. M., Wu, X. J., Cao, J., Jiao, J. & Chen, W. Association between cognitive frailty and adverse outcomes among older adults: a meta-analysis. J. Nutr. Health Aging 26, 817–825 (2022).

    Article  PubMed  CAS  Google Scholar 

  29. Chen, B. et al. Impact of frailty, mild cognitive impairment and cognitive frailty on adverse health outcomes among community-dwelling older adults: a systematic review and meta-analysis. Front. Med. (Lausanne) 9, 1009794 (2022).

  30. Verghese, J., Wang, C., Lipton, R. B. & Holtzer, R. Motoric cognitive risk syndrome and the risk of dementia. J. Gerontol. A Biol. Sci. Med. Sci. 68, 412–418 (2013).

    Article  PubMed  Google Scholar 

  31. Lin, Y. C. et al. The flexibility of physio-cognitive decline syndrome: a longitudinal cohort study. Front. Public Health 10, 820383 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  32. Chung, C. P. et al. Physio-cognitive decline syndrome as the phenotype and treatment target of unhealthy aging. J. Nutr. Health Aging 25, 1179–1189 (2021).

    Article  PubMed  Google Scholar 

  33. Moradi, S. et al. Hearing loss, hearing aid use and performance on the Montreal cognitive assessment (MoCA): findings from the HUNT study in Norway. Front. Neurosci. 17, 1327759 (2023).

    Article  PubMed  Google Scholar 

  34. Soons, L. M., Deckers, K., Tange, H., van Boxtel, M. P. J. & Köhler, S. Cognitive change in prevalent and incident hearing loss: the Maastricht Aging Study. Alzheimers Dement. 20, 2102–2112 (2024).

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  35. Chen, F. et al. Impact of hearing loss on cognitive function in community-dwelling older adults: serial mediation of self-rated health and depressive anxiety symptoms. Front. Aging Neurosci. 15, 1297622 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  36. Li, X. et al. Bidirectional associations between hearing difficulty and cognitive function in Chinese adults: a longitudinal study. Front. Aging Neurosci. 15, 1306154 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  37. Joo, H. H., Huang, E. Y., Schoo, D., Ward, B. & Chen, J. X. Association between hearing difficulty and mobility in adults of all ages: National Health Interview Survey. Otolaryngol. Head Neck Surg. 170, 1059–1065 (2023).

  38. Agmon, M., Lavie, L. & Doumas, M. The association between hearing loss, postural control and mobility in older adults: a systematic review. J. Am. Acad. Audiol. 28, 575–588 (2017).

    Article  PubMed  Google Scholar 

  39. Pupo, D. A. et al. Hearing and mobility in aging—the moderating role of neuropsychological function. J. Gerontol. A Biol. Sci. Med. Sci. 77, 2141–2146 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  40. Kawaharada, R. et al. Indirect effects of social activity on appetite via depressive symptoms in community-dwelling older adults: a cross-sectional study. Appetite 168, 105705 (2022).

    Article  PubMed  Google Scholar 

  41. Aprahamian, I. et al. The concept of anorexia of aging in late life depression: a cross-sectional analysis of a cohort study. Arch. Gerontol. Geriatr. 95, 104410 (2021).

    Article  PubMed  Google Scholar 

  42. Scheufele, P., Rappl, A., Visser, M., Kiesswetter, E. & Volkert, D. Characterisation of community-dwelling older adults with poor appetite. Eur. J. Nutr. 62, 1991–2000 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  43. Landi, F. et al. Prevalence and potentially reversible factors associated with anorexia among older nursing home residents: results from the ULISSE project. J. Am. Med. Dir. Assoc. 14, 119–124 (2013).

    Article  PubMed  Google Scholar 

  44. Frank, P. et al. Association between systemic inflammation and individual symptoms of depression: a pooled analysis of 15 population-based cohort studies. Am. J. Psychiatry 178, 1107–1118 (2021).

    Article  PubMed  Google Scholar 

  45. Komulainen, K. et al. Association of depressive symptoms with health care utilization in older adults: longitudinal evidence from the Survey of Health, Aging, and Retirement in Europe. Int. J. Geriatr. Psychiatry 36, 521–529 (2021).

    Article  PubMed  Google Scholar 

  46. Veltman, E. M. et al. Depressive subtypes in an elderly cohort identified using latent class analysis. J. Affect. Disord. 218, 123–130 (2017).

    Article  PubMed  CAS  Google Scholar 

  47. Maimaitiwusiman, Z. et al. Ethnic and geographic variations in multiple chronic conditions among community-dwelling older people in Xinjiang: a cross-sectional study. BMC Geriatr. 23, 455 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  48. Xu, T. et al. Association between home and community-based services and depressive symptoms in Chinese older adults: a multilevel analysis. BMC Public Health 23, 1406 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  49. González-Bautista, E., de Souto Barreto, P., Andrieu, S., Rolland, Y., Vellas, B. & MAPT/DSA group. Screening for intrinsic capacity impairments as markers of increased risk of frailty and disability in the context of integrated care for older people: secondary analysis of MAPT. Maturitas 150, 1–6 (2021).

  50. Ma, L. et al. Integrated Care for Older People screening tool for measuring intrinsic capacity: preliminary findings from ICOPE pilot in China. Front. Med. 7, 576079 (2020).

    Article  Google Scholar 

  51. Koivunen, K. et al. Exploring the conceptual framework and measurement model of intrinsic capacity defined by the World Health Organization: a scoping review. Ageing Res. Rev. 80, 101685 (2022).

  52. Rolland, Y. et al. Challenges in developing geroscience trials. Nat. Commun. 14, 5038 (2023).

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  53. Gonzalez-Bautista, E. et al. Reliability of self-screening for intrinsic capacity impairments using the ICOPE Monitor app. J. Frailty Aging 12, 291–297 (2023).

    PubMed  CAS  Google Scholar 

  54. Kwak, C., Seo, J. H., Oh, Y. & Han, W. Efficacy of the digit-in-noise test: a systematic review and meta-analysis. J. Audiol. Otol. 26, 10–21 (2022).

    Article  PubMed  Google Scholar 

  55. Gonzalez-Bautista, E. et al. Exploring the natural history of intrinsic capacity impairments: longitudinal patterns in the 10/66 study. Age Ageing 52, afad137 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  56. Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (General Data Protection Regulation). https://eur-lex.europa.eu/legal-content/EN/ALL/?uri=celex%3A32016R0679 (2016).

  57. Leung, A. Y. M., Su, J. J., Lee, E. S. H., Fung, J. T. S. & Molassiotis, A. Intrinsic capacity of older people in the community using WHO Integrated Care for Older People (ICOPE) framework: a cross-sectional study. BMC Geriatr. 22, 304 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  58. Fried, L. P. et al. Frailty in older adults: evidence for a phenotype. J. Gerontol. A Biol. Sci. Med. Sci. 56, M146–156 (2001).

    Article  PubMed  CAS  Google Scholar 

  59. Lawton, M. P. & Brody, E. M. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9, 179–186 (1969).

    Article  PubMed  CAS  Google Scholar 

  60. Katz, S., Downs, T. D., Cash, H. R. & Grotz, R. C. Progress in development of the index of ADL. Gerontologist 10, 20–30 (1970).

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

We thank all the healthcare professionals who participated in the ICOPE-Care program; the members of the Gerontopole of Toulouse, especially those of the ‘Regional Team for Ageing and Prevention of Dependency’ (I. Carrié, J. de Kerimel, C. Lafont, C. Mathieu, F. Paris, D. Pennetier, B. Rieunier and A. Robert-Millocco) and the ‘ICOPE remote monitoring platform’ (V. Bezombes, P. Baby, L. Bouchon, M. C. Cazes, F. Da Costa, N. Moussa, M. Poly, C. Seguela, L.-N. Sephan and C. Takeda); all the members of the Occitanie Territorial Teams of Ageing and Prevention of Dependency; and the project leaders of National Experimentation—Article 51 (Mutualité Française PACA, DAC Sante landes, Inter-CPTS Haut-Rhin, CPTS Haute-Corrèze, Perigueux University Hospital, Filieris Sud, Civic Hospitals of Lyon, CPTS Grand Sud Réunion, InterURPS Pay de la Loire, CPTS Cerebellum, DAC 17, DAC 46, Clinique des Augustines, Brest University Hospital and Mutualité Française Bretagne).

The ICOPE-Care program was supported by grants from the Occitania Regional Health Agency (Region Occitanie and Pyrénées-Méditerranée; reference no. 1901175), the European Regional Development Fund (project no. MP0022856) and the Interreg Program V-A Spain-France-Andorra (European Union) in the context of the APTITUDE project (reference no. EFA232/16). This work was performed in the context of IHU HealthAge, which has benefited from funding from the Agence Nationale de la Recherche under the France 2030 program (reference no. ANR-23-IAHU-0011). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the paper.

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Authors and Affiliations

  1. IHU HealthAge, Toulouse, France

    Philipe de Souto Barreto, Emmanuel Gonzalez-Bautista, Heike A. Bischoff-Ferrari, Sandrine Andrieu, Caroline Berbon, Neda Tavassoli, Yves Rolland, Maria Eugenia Soto Martín & Bruno Vellas

  2. CERPOP UMR 1295, University of Toulouse III, INSERM, UPS, Toulouse, France

    Philipe de Souto Barreto, Emmanuel Gonzalez-Bautista, Sandrine Andrieu, Yves Rolland, Maria Eugenia Soto Martín & Bruno Vellas

  3. Institute on Aging of the Toulouse University Hospital (CHU Toulouse), Toulouse, France

    Philipe de Souto Barreto, Emmanuel Gonzalez-Bautista, Vitor Pelegrim de Oliveira, Yves Rolland, Maria Eugenia Soto Martín & Bruno Vellas

  4. Department of Geriatrics and Aging Research, University of Zurich, Zurich, Switzerland

    Heike A. Bischoff-Ferrari

  5. Geriatric Unit – Internal Medicine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil

    Vitor Pelegrim de Oliveira & Renato Gorga Bandeira de Mello

  6. International Longevity Center – USA, Columbia University, New York, NY, USA

    John R. Beard

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Contributions

P.d.S.B., E.G.-B., M.E.S.M. and B.V. contributed to the study design and supervised the study. N.T., C.B. and E.G.-B. contributed to data collection and/or verification. E.G.-B. analyzed the data. P.d.S.B., E.G.-B., H.A.B.-F., V.P.O., R.G.B.M., C.B., N.T., J.R.B., Y.R., M.E.S.M. and B.V. contributed to data interpretation. P.d.S.B. wrote the first version of the paper. All authors revised the paper for important intellectual content. All authors had full access to all the data in the study and had final responsibility for the decision to submit for publication.

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Correspondence to Philipe de Souto Barreto.

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Competing interests

P.d.S.B. received research grants and consultancy fees from Pfizer. B.V. is the founder president of IHU HealthAge at Toulouse University Hospital and is an investigator in clinical trials sponsored by several industry partners (IHU, CRC and Inspire geroscience platforms). The other authors declare no competing interests.

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Extended data

Extended Data Fig. 1 Flow chart of study population.

Sample size varied according to the analysis undertaken (cross-sectional or longitudinal).

Extended Data Fig. 2 Goodness-of-fit statistics for the latent class analysis by number of latent statuses using the baseline ICOPE Step1 (cross-sectional) data from healthcare professional assessments.

Results of the goodness-of-fit statistics identify the four clusters as the best fit for the data.

Supplementary information

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de Souto Barreto, P., Gonzalez-Bautista, E., Bischoff-Ferrari, H.A. et al. Real-life intrinsic capacity screening data from the ICOPE-Care program. Nat Aging 4, 1279–1289 (2024). https://doi.org/10.1038/s43587-024-00684-2

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