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Community-Based ICOPE Screening Identifies Intrinsic Capacity Impairment and Supports Integrated Health and Social
Reshma Aziz Merchant1, Yang Liu2, Li Feng Tan3
1Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore.
Journal of the American Medical Directors Association
|August 4, 2026
Summary
Implementing the World Health Organization
Area of Science:
- Gerontology
- Public Health
- Integrated Care Models
Background:
- The World Health Organization (WHO) Decade of Healthy Aging emphasizes preserving intrinsic capacity (IC) and delaying functional decline.
- Integrated Care for Older People (ICOPE) is a key WHO framework for addressing the complex needs of older adults.
- Community-based systems are crucial for delivering accessible and sustained health and social care for aging populations.
Purpose of the Study:
- To evaluate the feasibility of implementing a WHO ICOPE-aligned pathway within routine community systems.
- To determine the prevalence and patterns of intrinsic capacity impairment among community-dwelling older adults.
- To describe the process of risk stratification and care planning following IC assessment.
Main Methods:
- A pragmatic, prospective, multisite implementation study was conducted in Singapore.
- 649 community-dwelling older adults aged 60+ underwent ICOPE screening and a 6-domain IC assessment.
- Participants received geriatrician-led multidisciplinary review, individualized care planning, and structured referrals within routine workflows.
Main Results:
- 81.5% of participants exhibited impairment in at least one IC domain, with 55.5% showing multidomain impairment despite preserved functional independence.
- The most prevalent impairments were in vitality (46.8%), cognition (37.4%), and vision (38.2%).
- Multidisciplinary review facilitated risk stratification and connected individuals to essential community, primary care, and social services.
Conclusions:
- Community-based implementation of the WHO ICOPE pathway is feasible and effectively identifies significant multidomain IC impairment in independent older adults.
- Variations across sites underscore the need for tailored service planning and resource allocation.
- Integrating IC screening and coordinated referrals into community platforms supports early intervention for functional decline and promotes integrated care.
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