|Year : 2021 | Volume
| Issue : 4 | Page : 103-104
Integrated care for older people (ICOPE)
Senior Professor (Medicine) and Head of Department (Geriatric Medicine), Government Medical College, Kota, Rajasthan, India
|Date of Web Publication||21-Dec-2021|
Senior Professor (Medicine) and Head of Department (Geriatric Medicine), Government Medical College, Kota, Rajasthan
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sharda M. Integrated care for older people (ICOPE). J Indian Acad Geriatr 2021;17:103-4
Demographic transition by the ageing population globally is thrusting an impact on almost all aspects of society. Many older people, particularly from low -or middle-income countries, do not have access to the essential resources of a meaningful and dignified social life. Hence an urgent need is felt for composite global action. The proclamation of the United Nations Decade of Healthy Ageing (2021-2030), aligned with the last ten years of the Sustainable Development Goals (SDGs), is a significant step in that direction. The seventeen SDGs must be implemented by every country globally. Therefore, older people's inclusion in the SDGs is essential to leave no one behind. The objectives of the decade of healthy ageing will be attained by global collaboration bringing together governments, civil society, international agencies, professionals' academia, media, and the private sector to improve the lives of older people, their families, and the communities in which they live. Integrated care is one of the four action areas of the Decade of Healthy Ageing.
The 2015 world report on ageing and health outlined the goal of healthy ageing as helping people to develop and maintain the functional ability that enables wellbeing. Functional ability is defined as the “health-related attributes that enable people to be and to do what they have reason to value”. Functional ability consists of the intrinsic capacity of the individual, the environment of the individual and the interactions between them. The intrinsic capacity is “the composite of all the physical and mental capacities that an individual can draw on”.
The conventional approach to health care for older people mainly focuses on diagnosing and managing the medical illness, overlooking the attitude of ageism and losses in an intrinsic capacity. Most healthcare professionals lack the guidance and training to recognize and effectively manage declines in intrinsic capacity. As the population is ageing, there is a pressing need to develop comprehensive community-based approaches that include interventions to prevent declines in intrinsic capacity, foster healthy ageing and support caregivers of older people. Therefore, in 2015 the Guideline Development Group (GDG) of the World Health Organization (WHO) formulated the guidelines and recommendations on declining physical and mental abilities, geriatric syndromes, and caregiver support, which finally led to the birth of a concept of “ICOPE”-Integrated Care for Older People in 2017.
Besides print versions, these guidelines are also available electronically at a dedicated section of the WHO website (http://www.who.int/ageing/healthsystems/icope) and digitally in the “ICOPE Handbook APP”, a digital app to implement ICOPE in community and primary care settings. The app guides the assessments, interventions and care plans and generates a printable summary The WHO Department of Ageing and Life Course developed ICOPE with rigorous scientific methodology and continues monitoring and updating it.
The “ICOPE”, a community based, person-centred comprehensive care approach for older people linking health and social care, is to be delivered in the following five steps.
Step 1: Screen for losses in intrinsic capacity (using the ICOPE: Intrinsic Capacity Assessment Tool)
Step 2: Undertake a person-centred assessment
Step 3: Define the goal of care and develop a personalized care plan
Step 4: Ensure referral pathways and monitoring of care plan
Step 5: Engage communities and support caregiver.
The ICOPE recommendations offer care pathways to manage priority health conditions associated with declines in intrinsic capacity – loss of mobility, malnutrition, visual impairment, hearing loss, cognitive decline, depressive symptoms. These pathways start with a screening test by health and social care workers in the community where the older person and caregivers live, followed by more in-depth person-centred assessment and the development of personalized care plans by trained health professionals in a primary healthcare setting. The care plan aims to reverse, slow or prevent further declines in capacity, treat diseases and meet the social care needs of an older adult. Beard J et al. described the rationale and evidence base for providing person-centred and integrated care to older adults.
The southeast region is home to a large proportion of the world's ageing population, and more needs to be done for the health care of these people in terms of human resource development. Human resources training should be of good quality with uniform content and involvement of the state and professional associations covering physicians both from public and private sectors. World Health Organization South-East Asia Regional Office (WHO SEARO) prepared training resources based on ICOPE to train health care workers of all types (physicians, nurses, front line health workers) and volunteers in LTC facilities.
Primarily health and social care workers in the community and primary care settings will be the training targets by these modules. The guidance will enable them to screen, assess, and identify the older adult with loss of intrinsic capacity and functional ability and the need for specialized knowledge for a person-centred care plan.
Recently the Indian Academy of Geriatrics, with the support of WHO SEARO, conducted training of master trainers for primary care physicians on Integrated Care for Older People. In addition, members of the professional bodies of the region viz Bangladesh Association for the Aged and Institute of Geriatric Medicine, Sri Lankan Association of Geriatric Medicine, Geriatric Society of Nepal, Indonesian Geriatric Association, Mahidol University, Thailand, and Non-Governmental Organizations (HelpAge India, Jan Seva foundation, ACMERI) actively participated in the online training. As a result, one hundred thirty-six physicians from India, Indonesia, Thailand, Nepal, Sri Lanka, and Bangladesh were trained by facilitators from India, Thailand, Nepal, Sri Lanka and Myanmar. These master trainers will deliver training to primary care physicians and community health care workers, which will help them impart easily accessible, effective, and comprehensive health care to every older adult.
Physicians could easily adopt the ICOPE approach in clinical practice. Besides comprehensive clinical evaluation, the ICOPE approach emphasizes supporting social care and caregivers. A partnership involving the older person, treating physician, primary healthcare workers, family and community as envisaged in ICOPE will sustain people's wellbeing as they age. The ICOPE will contribute significantly to achieving the decade's goals of healthy ageing.
| References|| |
Beard JR, Officer A, de Carvalho IA, Sadana R, Pot AM, Michel J-P, et al
. The world report on ageing and health: a policy framework for healthy ageing. Lancet 2016;387 (10033):2145-54.