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NCT Number: NCT07525583

Implementation of Decade of Healthy Ageing Action Plan to Screen and Prevent Decline in Intrinsic Capacity in Elders (SPICE) Through Multisectoral Collaboration in Singapore

This study evaluates the implementation of a structured community-based pathway to screen, risk stratify, and prevent decline in intrinsic capacity (IC) among adults aged 60 years and above in Singapore. Using the World Health Organization (WHO) Integrated Care for Older People (ICOPE) framework and digital screening tools, participants will undergo IC domain screening in community settings. Individuals identified with early decline will receive targeted multidomain interventions and/or referral to primary or specialist care as indicated. Participants will be followed longitudinally to assess feasibility, uptake, functional trajectories, and implementation outcomes.

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Key information

Conditions

Frailty Intrinsic Capacity Lifestyle Pathologic Processes Pathological Conditions, Signs and Symptoms

Age range

60 year and older

Sex eligibility

All sexes

Study type

Observational

Primary location

National University Hospital

Singapore

Location status: Recruiting

Location contact

Li Feng Tan, MBBS

SUB_INVESTIGATOR

Reshma Merchant, MBChB

PRINCIPAL_INVESTIGATOR

Sophie Swe Mar Tun

CONTACT

[email protected]

+6589129558

About this study

Population ageing is associated with progressive decline in intrinsic capacity (IC), defined by WHO as the composite of physical and mental capacities across mobility, cognition, vitality (nutrition), psychological, and sensory domains. Early detection of IC decline enables preventive, person-centred interventions to delay frailty, disability, and long-term care dependency.

The SPICE study operationalises the WHO ICOPE framework within Singapore's community ageing ecosystem through a coordinated hub-and-spoke model linking:Community screening platforms (e.g., Active Ageing Centres), Community Health Posts, Regional health system services and other social service organisations.

The pathway consists of:

Step 1: IC Screening

  • Screening using WHO ICOPE Monitor tools. Step 2: In-Depth Assessment
  • Participants screening positive for decline undergo structured assessment of affected domains.

Step 3: Risk Stratification & Care Planning

  • Traffic-light classification (low, moderate, high risk) with personalised care plans.

Step 4: Intervention & Referral

  • Multidomain community interventions (exercise, nutrition, cognitive stimulation, psychosocial engagement) or escalation to medical services when required.

Step 5: Monitoring & Follow-up

  • Longitudinal follow-up with repeat IC assessments at defined intervals. The study will evaluate implementation feasibility, prevalence of IC decline, adherence to care pathways, functional outcomes, and cost-effectiveness within a real-world community system.

In addition, blood and digital biomarkers will be collected from a subgroup of study participants.

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • pre-frail or robust older adults who can provide consent and follow instructions

Exclusion criteria

  • frail or with terminal illness

Treatment and study plan

ICOPE-Based Digital Intrinsic Capacity Monitoring and Triggered Follow-up (SPICE Pathway)

Other

Participants will undergo baseline intrinsic capacity (IC) screening using WHO ICOPE-aligned tools in community settings. Follow-up contacts/visits will occur over the study period and include:

  • Scheduled follow-up at predefined intervals (e.g., every 3, 6-12 months) for repeat IC assessment and outcome data collection; and
  • Triggered (non-scheduled) follow-up that is initiated when remote/digital monitoring indicates decline in one or more IC domains, poor adherence, or when major intercurrent clinical events are reported/identified, prompting in-depth assessment, care plan adjustment, and referral to Community Health Posts, primary care, or specialist services as appropriate.

Primary outcomes

  1. Prevalence of intrinsic capacity decline at baseline (robust / pre-frail)

    Time frame: Baseline

    Proportion of participants (restricted to robust and pre-frail at baseline) with ≥1 impaired IC domain on screening; and proportion impaired by each domain (mobility, cognition, vitality, psychological, sensory).

  2. Uptake of recommended actions (implementation effectiveness)

    Time frame: Up to 3 months post-recommendation

    Proportion of participants who initiate at least one recommended action within a defined window after screening/plan (e.g., enrolment in a prescribed community programme, completion of recommended assessment, or attendance at a referred service).

Secondary outcomes

  1. Identification of (a set of) biomarkers of aging

    Time frame: 30 months

    Both blood biomarkers and digital markers associated with various intrinsic capacity

  2. Feasibility and reach

    Time frame: 30 months

    Proportion of individuals in each community setting complete both Step 1 and Step 2 assessment.

  3. Change in intrinsic capacity and function over time

    Time frame: 12 months from enrolment

    Change in number of impaired IC domains (0-5) from baseline to follow-up.

  4. Frailty progression

    Time frame: over 12 months follow up

    Proportion transitioning from robust → pre-frail/frail; pre-frail → frail

  5. Cost per participant screened

    Time frame: 3 years

    Programme delivery cost from the provider/programme perspective, calculated as total programme delivery cost divided by the number of participants screened; costs include personnel, training, digital platform/monitoring, screening and assessment delivery, and intervention coordination.

  6. Number of participants with at least one unscheduled emergency department visit or hospital admission

    Time frame: 12 months

    Number and proportion of participants with at least one unscheduled emergency department visit or unplanned hospital admission during follow-up, based on participant report and/or clinical records where available.

  7. Implementation outcomes assessed using RE-AIM framework

    Time frame: 3 years

    Reach: Proportion of eligible older adults screened, characteristics of participants.

    Effectiveness: Proportion of participants with identified IC impairment who receive recommended follow-up actions, including referral to community services, primary care, or multidisciplinary assessment.

    Adoption: Provider-reported acceptability and perceived usefulness of the screening pathway (measured using an adapted 8-item questionnaire based on the Theoretical Framework of Acceptability (TFA)).

    Implementation: Adherence to screening protocols among providers, completion of Step 1 and Step 2 assessments, and referral processes. Implementation strategies, barriers, and facilitators will also be documented by qualitative method.

    Maintenance: Continued delivery of IC screening at participating sites, and Integration of the programme into routine community health services. The 23-item Normalization Measure Development questionnaire (NoMAD) and the 12-item SCIROCCO tool will be used.

Study contacts

Contact information is provided by the study sponsor or research team.

Reshma Merchant (Associate Professor), MBChB (Edin)

CONTACT

[email protected]

+6567724368

Sponsors and collaborators

Lead sponsor

National University Hospital, Singapore

Other

Registry information

Acronym: SPICE

Important dates

Study start
2025
Primary completion
2027
Study completion
2027
First posted
Apr 13, 2026
Registry last updated
Apr 13, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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