October 1 is the International Day of the Older Person, and the World Health Organization (WHO) has released new guidelines on community-level interventions to manage declines in intrinsic capacity of older people a few days earlier.
Background Information:
Intrinsic capacity is the composite of all the physical and mental capacities of an individual;
Functional ability is the combination and interaction of intrinsic capacity with the environment a person inhabits.
Key Messages:
By the year 2050, 1 in 5 people in the world will be aged 60 and older.
Even in the rich world, people may not be getting the integrated services they need. In a survey of 11 high-income countries, up to 41% of older adults (age ≥65 years) reported care coordination problems in the past two years.
Older adults are more likely to experience chronic conditions and often multiple conditions at the same time. Yet today’s health systems generally focus on the detection and treatment of individual acute diseases.
The WHO Guidelines on Integrated Care for Older People (ICOPE) propose evidence-based recommendations for health care professionals to prevent, slow or reverse declines in the physical and mental capacities of older people. These recommendations require countries to place the needs and preferences of older adults at the centre and to coordinate care.
The ICOPE Guidelines will allow countries to improve the health and well-being of their older populations, and to move closer to the achievement of universal health coverage for all at all ages.
The ICOPE guidelines offer evidence-based direction on:
- comprehensive assessment of health status in an older person
- delivery of the integrated health care that will enable an older person to maintain their physical and mental capacities, and/or to slow or reverse any declines in these
- delivery of interventions to support caregivers.
The ICOPE guidelines will assist health care professionals in clinical settings to detect declines in physical and mental capacities and to deliver effective interventions to prevent and delay progression.
Important elements of integrated care at the community level are:
- a comprehensive assessment and care plan shared with all providers
- common care and treatment goals across different providers
- community outreach and home-based interventions
- support for self-management
- comprehensive referral and monitoring processes
- community engagement and caregiver support.
Recommendations:
A. Improve Musculoskeletal function, mobility and vitality
- Multimodal exercise, including progressive strength resistance training– for those with declining physical capacity
- Oral supplemental nutrition with dietary advice– for those affected by undernutrition
B. Maintain sensory capacity
3. Routine screening for visual impairment in the primary care setting, and timely provision of comprehensive eye care
4. Screening followed by provision of hearing aids should be offered to older
people for timely identification and management of hearing loss
C. Prevent severe cognitive impairment and promote psychological well being
5. Cognitive stimulation can be offered to older people with cognitive impairment,
with or without a formal diagnosis of dementia
6. Older adults who are experiencing depressive symptoms can be offered brief,
structured psychological interventions, in accordance with WHO mhGAP
intervention guidelines delivered by health care professionals with a good
understanding of mental health care for older adults.
D. Manage age-associated conditions such as urinary incontinence
7. Prompted voiding for the management of urinary incontinence can be offered
for older people with cognitive impairment
8. Pelvic floor muscle training, alone or combined with bladder control strategies
and self-monitoring, should be recommended for older women with urinary
incontinence (urge, stress or mixed).
E. Prevent Falls
9. Medication review and withdrawal (of unnecessary or harmful medication) can
be recommended for older people at risk of falls
10. Multimodal exercise (balance, strength, flexibility and functional training) should
be recommended for older people at risk of falls
11. Action on hazards – following a specialist’s assessment, home modifications to
remove environmental hazards that could cause falls should be recommended for
older people at risk of falls
12. Multifactorial interventions integrating assessment with individually tailored
interventions can be recommended to reduce the risk and incidence of falls among
older people.
F. Support Caregivers
13. Psychological intervention, training and support should be offered to family
members and other informal caregivers of care-dependent older people,
particularly but not exclusively when the need for care is complex and extensive
and/or there is significant caregiver strain.
Useful Links:
Link to WHO news release:
http://who.int/mediacentre/news/releases/2017/health-older-people/en/
Link to WHO’s ICOPE brochure (English) [PDF]:
http://who.int/ageing/WHO-ALC-ICOPE_brochure.pdf?ua=1
Link to the full ICOPE guidelines (English) [PDF]:
http://apps.who.int/iris/bitstream/10665/258981/1/9789241550109-eng.pdf?ua=1
communitymedicine4all 