China Pilot of ICOPE (Integrated Care for Older People) in Chaoyang

The goal of this pilot study is to evaluate the feasibility of implementing World Health Organization's ICOPE (integrated care for older people) approach in China. The main questions it aims to answer are:

• Whether it is feasible to implement the ICOPE approach in China;
• Whether the integrated care approach would make any difference in health outcomes and resource utilization.

For the first question, predefined parameters such as sample size, capacity building, acceptance by community-dwelling older people (participants) and care providers were examined.

Based on literature review and also as evidenced in the background study of the ICOPE guideline development process, a key hypothesis is that implementing integrated care management programs can improve health outcomes while containing costs.

According to the pilot study design, a total of 2000 community-dwelling older persons aged 60 and above at-risk of functional loss in Chaoyang District of Beijing are recruited and randomly assigned to the intervention group (n=500) and control group (n=1500).

Chaoyang is the most populated district in Beijing, with subdistricts that are urban, suburban and rural, well representing the city of Beijing. To identify potential participants who are at risk of functional loss, the pilot used ICOPE screening tools in the recruitment process, to screen for any losses in mobility, cognition, vitality, psychological health, vision and hearing.

Screening tools used are:

• Independence is measured by the activities of daily living (ADL) 14-questionnaire scale.
• Cognition is measured by mini-mental status examination (MMSE).
• Vitality or nutrition is measured by by mini-nutritional assessment- short form (MNA-SF) to assess the risk of malnutrition.
• Mobility is measured by short physical performance battery (SPPB).
• Psychological health is measured by geriatric depression scale-five items (GDS-5).

Inclusion criteria

• Screened as positive for intrinsic capacity declines
• Decline in intrinsic capacity confirmed by in-depth assessment in any of the domains described as: MMSE < 27 (for cognition), SPPB ≤ 9 (for locomotion), MNA-SF <12 (for vitality we used nutrition as a proxy), GDS-5 ≥ 2 (for psychology we used depression as a proxy) or any vision impairment
• Signed form of consent and willingly participate in the pilot study

Exclusion criteria

• Negative results in their intrinsic capacity decline screening
• Severe hearing problems as the study was conducted during COVID-19 pandemics period and relied on telecare or remote sessions of intervention