Understanding and maintaining intrinsic capacity is essential for promoting healthy aging. This course will empower caregivers with the knowledge to support older adults in preserving their physical and mental capacities. Taking this course will help you understand the concept of intrinsic capacity and how to measure it using the ICOPE screening tool.
Chapter 1
Chapter 1 - Understanding Intrinsic Capacity
We have studied the concept of healthy ageing and the interrelation between functional ability, intrinsic capacity, and environmental characteristics in MOOC 14 Demand on your CARE: Presentation of illness symptoms in older adults. (You may click here for a quick revision.)
We all know that being free of diseases doesn't necessarily mean you are healthy. From experience, most older adults not only desire longevity but also want to live independently and with dignity. In this course, we will further explore what intrinsic capacity is. In this chapter, we will gain a deeper understanding of each domain of intrinsic capacity.
Let's start with the below animation.
1. What is intrinsic capacity?
What is intrinsic capacity
The concept of intrinsic capacity was introduced by the World Health Organization in 2015.
Intrinsic capacity comprises all the mental and physical capacities that a person can draw on.
It includes their ability to walk, think, see, hear, and remember.
The level of intrinsic capacity is influenced by several factors, such as the presence of diseases, injuries, and age-related changes.
It represents an individual's overall combination of physical and mental abilities, which play a crucial role in maintaining functional independence and well-being as we age.
IC was found to be associated with polypharmacy, incontinence, poor/fair self-rated health, frailty, falls, and long-term nursing home stay.
Why is intrinsic capacity important for healthy ageing?
Intrinsic capacity plays a crucial role in promoting healthy ageing.
Holistic Approach: Unlike traditional disease-centered models, which focus solely on specific illnesses, intrinsic capacity considers a broader perspective. It looks at an older person's functional abilities as a whole, emphasizing their ability to be and do what they value most.
Determinants: Intrinsic capacity is influenced by various factors, including genetics, physiological changes due to ageing, diseases, injuries, and lifestyle choices. It interacts with the physical and social environment to enable activities of daily living (ADL) and participation.
Health Monitoring: By assessing intrinsic capacity, healthcare professionals can identify fundamental determinants of functional ability in older adults. This provides an opportunity for early intervention to maintain or enhance an individual's abilities as they age.
Personalized Care: Health priorities vary widely among older individuals. Intrinsic capacity allows for a personalized approach, recognizing that each person's needs and abilities are unique.
Domains of intrinsic capacity
The domains of intrinsic capacity are interconnected, an issue in one domain can affect multiple other domains.
It is essential to maintain all domains effectively for healthy ageing. That means, you cannot only want to maintain your memory and ignore the others because they all have an effect in each other.
6 key domains of intrinsic capacity (IC):
Vitality
Locomotor capacity
Psychological capacity
Cognitive capacity
Hearing capacity
Visual capacity
Key domains supporting the construct of intrinsic capacity in older adults
(Cesari et al., 2018)
Figure 2. The five domains (i.e., locomotion, sensory, cognition, psychological, vitality) constituting the intrinsic capacity construct. Examples of possible subdomains are also provided.
Reflection 1
Imagine, when an older adult walk across the road, how do these key domains of intrinsic capacity collectively enable him to navigate this everyday task safely and independently?
Locomotion
An older person needs to walk across the street quickly and steadily to avoid oncoming traffic.
Locomotor capacity ensures they have the strength and mobility to do this safely.
Cognition
While crossing the road, the older person must process information quickly, like identifying the pedestrian signal, assessing the speed of approaching vehicles, and deciding when it's safe to cross. Cognitive capacity involves their ability to think, remember, and make decisions in such situations.
Psychological
The confidence and emotional well-being to cross the road without feeling overly anxious or fearful.
Psychological capacity affects how comfortable and secure the older person feels in performing daily activities, including crossing the road.
Vision
Sensory capacity includes vision and hearing. The older person needs to see the traffic lights and hear any warnings or sounds from vehicles to cross safely. Any impairment in their sensory capacity could make crossing the road more challenging.
Hearing
Vitality
Vitality refers to overall energy levels and physical health. An older person with good vitality will have the stamina to walk across the road at a consistent pace without becoming overly fatigued.
Reflection 2
Can you give some examples that illustrating the domains of intrinsic capacity are interconnected?
Prevalence and distribution of intrinsic capacity in HK
A local study in the prevalence and distribution of intrinsic capacity in 2022
Among 10007 community-dwelling people aged 60 years and older (mean age 75.7±7.9 years) were interviewed at baseline:
IC impairments are highly prevalent in HK.
85.3% had impairments in one or more IC domains.
Cognitive (71.3%), locomotor (45.8%), and sensory (vision) capacities (22.8%) were the three domains more frequently affected.
The prevalence of IC impairments increased with age, and women had a greater number of impaired IC domains than men.
Among the 1,601 participants who were interviewed at each follow-up:
Those with impairments in three or more domains had increased risks of
highlighted the need for increasing community capacity in providing assessments and interventions.
underscored the potential of IC as a screening measure for interventions in the care of older people, supporting the World Health Organization's strategy of focusing on optimizing or maintaining IC for healthy ageing.
(Yu and Leung et al., 2022)
Reference
Cesari, M., de Carvalho, I. A., Thiyagarajan, J. A., Cooper, C., Martin, F. C., Reginster, J. Y., Vellas, B., & Beard, J. R. (2018). Evidence for the domains supporting the construct of intrinsic capacity. The Journals of Gerontology: Series A, 73(12), 1653–1660.
https://doi.org/10.1093/gerona/gly011
Yu, R., Leung, G., Leung, J., et al. (2022). Prevalence and distribution of intrinsic capacity and its associations with health outcomes in older people: The Jockey Club Community eHealth Care Project in Hong Kong. Journal of Frailty & Aging, 11(3), 302-308.
http://dx.doi.org/10.14283/jfa.2022.19
Yu, R., Lai, E. T. C., Leung, G., Ho, S. C., & Woo, J. (2022). Intrinsic Capacity and 10-year Mortality: Findings from A Cohort of Older People. Experimental gerontology, 167, 111926.
https://doi.org/10.1016/j.exger.2022.111926
- End of Chapter 1 -
Chapter 2
Chapter 2 - Introduction to ICOPE and its Significance in Identifying Older Adults with Reduced Intrinsic Capacity
2. Integrated care for older people
What is ICOPE?
The Integrated Care for Older People (ICOPE) is a comprehensive framework developed by the World Health Organization (WHO) to address the diverse and complex needs of older adults.
The primary objective of ICOPE is to promote healthy aging by maintaining and enhancing the intrinsic capacity of older individuals. As people age, various factors can affect their intrinsic capacity, leading to declines in their functional abilities.
ICOPE reflects a continuum of care that will help to reorient health and social services towards a more person-centred and coordinated model of care.
It provides a set of tools and guidelines for healthcare providers, caregivers, and communities to assess, monitor, and manage the intrinsic capacity of older adults effectively.
The ICOPE framework
The ICOPE framework represents a significant advancement in the approach to elder care by focusing on intrinsic capacity. It highlights the importance of early identification, comprehensive assessment, personalized interventions, and integration with community resources to promote healthy ageing. By adopting the ICOPE approach, healthcare providers and caregivers can significantly improve the quality of life for older adults, helping them to maintain their independence and well-being as they age.
There are five key steps to meeting older people's health and social care needs with an integrated care approach:
(World Health Organization, 2017a)
Significance in Identifying Older Adults with Reduced Intrinsic Capacity
Let's watch the below animations to understand how to measure the six key domains of intrinsic capacity through ICOPE.
3. ICOPE (Nutrition)
4. ICOPE (Locomotion)
5. ICOPE (Vision)
6. ICOPE (Hearing)
7. ICOPE (Cognition)
8. ICOPE (Psychological Capacity)
ICOPE priority actions suggested by WHO
The ICOPE Evidence Resource Center provides the evidence profiles and recommendations used to develop the ICOPE Guidelines on community-level interventions to manage declines in intrinsic capacity in older people. These evidence profiles and recommendations were produced from a synthesis of a series of systematic reviews of the best available evidence for community-level care for older people. A guideline development group convened by WHO formed these recommendations by consensus, supported by input from a wide range of stakeholders.
The evidence profiles are organized around the 6 ICOPE priority actions:
Improve musculoskeletal function, mobility and vitality
Maintain sensory capacity
Prevent severe cognitive impairment and promote psychological well-being
Manage age-associated conditions such as urinary incontinence
Prevent falls
Support caregivers
(World Health Organization, 2017a)
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The videos in this course provide information for educational purposes only. The videos do not provide medical recommendations or diagnoses and are not substitutes for medical advice. It is crucial that you talk with your healthcare providers to discuss any questions you may have and seek them for medical advice, before you make any medical decisions. We will not be responsible for any decisions you will make or consequences you will have based on the information provided.
None of The Hong Kong Jockey Club Charities Trust, The Hong Kong Jockey Club, their respective affiliates or any other person involved in or related to the compilation of the contents herein (collectively, "the HKJC Parties") makes any express or implied warranties or representations with respect to the accuracy, timeliness or completeness of the contents or as to the results that may be obtained by the use thereof. In no event shall any HKJC Party have any liability of any kind to any person or entity arising from or related to any actions taken or not taken as a result of any of the contents herein.
