|Year : 2022 | Volume
| Issue : 2 | Page : 41-42
Ready, Set, and Go!
Venugopalan Gunasekaran1, Arvind Mathur2
1 Department of Geriatric Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
2 Dr. S N Medical College, Jodhpur, Rajasthan, India
|Date of Submission||10-Jun-2022|
|Date of Decision||10-Jun-2022|
|Date of Acceptance||10-Jun-2022|
|Date of Web Publication||15-Jul-2022|
Dr. S N Medical College, Jodhpur, Rajasthan
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gunasekaran V, Mathur A. Ready, Set, and Go!. J Indian Acad Geriatr 2022;18:41-2
United Nations Decade of Healthy Ageing (2021–2030) announcement was obscured by the pandemic response. However, the four action areas are (i) changing how we think, feel, and act toward age and aging; (ii) developing communities in ways that foster the abilities of older people; (iii) delivering person-centered integrated care and primary health services responsive to older people; and (iv) providing older people who need it with access to long-term care. The personalized and integrated care of older adults revolves around the Comprehensive Geriatric Assessment – a multidimensional, multidisciplinary assessment and care plan, which is often time-consuming and shunned in places with a shortage of specialists. The WHO's Integrated Care of Older Persons (ICOPE) paves the path for a quick, personalized assessment and care plan that can be followed in communities. The WHO's ICOPE approach will help reorient health and social services toward a more person-centered and coordinated model of care that supports optimizing older people's intrinsic capacity (physical and mental capacities) and functional ability.
The ICOPE screening tool focuses on six components of intrinsic capacities of an older adult – cognition, vitality, locomotion, vision, hearing, and depression. Five steps of ICOPE care pathways for assessing these domains and social care and caregiver support systems integrate older persons' physical, mental, and social healthcare. There is a need and scope to include other components such as quality of life, self-reported health status, and individual priorities in the ICOPE screening tool.
The WHO is conducting a three-phase research project, the “ICOPE implementation pilot program,” comprising ready, set, and go phases to support member states. The readiness and feasibility of implementing ICOPE were assessed at the service and system levels in the ready phase.
At the clinical and service levels, the studies focused primarily on the views and experiences of health and care workers through an online micro survey and four country case studies. Rajasthan (India) was one of the four country case studies of the ready phase, the others being Canillo (Andorra), Chaoyang in Beijing (China), and Occitanie (France), and the report of which was published recently. The proportion of older adults with potential decline in intrinsic capacity varied in frequency in the four countries studied in this phase. In Rajasthan, the frequency of potential decline in intrinsic capacity (N = 451) was hearing loss (68%), loss of mobility (52%), visual impairment (49%), malnutrition (34%), cognitive decline (32%), and depressive mood (19%). The three other countries also did an in-depth assessment of the decline in intrinsic capacity, where there were changes in the frequency of conditions. In-depth assessment in Rajasthan was affected due to the pandemic situation. Most participants (>70%) in China and France wanted to continue with the ICOPE care.
At the service and system levels, the study utilized the ICOPE implementation framework through an online implementation scorecard survey to assess the capacity to deliver integrated care. Data were collected from 260 completed responses from healthcare personnel (38.8% medical doctors, 21.5% nurses) representing 29 member countries, i.e., 19.2% from lower-middle-income, 23.5% from upper-middle-income, and 57.3% from high-income countries. The majority responded that to assess the decline in intrinsic capacity (steps 1, 2), they need staff (65%), training (70%), and space (40%). Only a meager proportion responded that they have support from local government (35%), civil society organizations (25%), and academic associations (29%) to assess the decline in intrinsic capacity. Access to essential medicines was only in 19% of the cases. Hence, even for the basic step of evaluating the decline in intrinsic capacity, there is a huge mismatch in the demand and supply in the survey, represented mainly by high- and upper-middle-income countries. The situation in lower- and middle-income countries will be pretty much dismal [Figure 1] and [Figure 2]. When we look at other steps such as assessment and management of diseases and associated conditions (steps 2 and 3), assessment and management of social and physical environments, social care and support (step 3), develop a personalized care plan (step 3), and referral pathway and monitoring of care plan (step 4), the situation is almost similar. There is better preparedness in enabling parameters in engaging communities and supporting caregivers (step 5).
|Figure 1: Total implementation readiness score (0-52); higher the score is better readiness. HIC: High-income country, UMIC: Upper-middle-income country, LMIC: Lower-middle-income country, LIC: Low-income country|
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|Figure 2: Services and system implementation readiness score (0-26); higher the score better is readiness. HIC: High-income country, UMIC: Upper-middle-income country, LMIC: Lower-middle-income country, LIC: Low-income country|
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The additional time required and lack of available staff are the significant barriers to the implementation of ICOPE found in this survey. Hence, there is a need for systems and services support, training to build workforce capacity, the addition of digital tools to support service delivery, and the importance of community engagement and support to implement ICOPE in forthcoming years. In addition, the digital tools can enable resource-constrained communities to utilize the ICOPE approach.
The key takeaway from the report is that the frequency of decline in intrinsic capacity is high among older adults who expressed positive attitudes toward the ICOPE approach, agreeing that integrated care is vital for a better aging process. In addition, health and care workers consistently identified the proactive engagement of older people as a critical enabler across all steps of the ICOPE care pathway. Thus, the need to scale up the facilities to implement ICOPE screening and personalized care plans is very high. We have a huge task to get things rolling before the tsunami of the aging population hits us in the future. Now is the time to focus all our attention on enabling an environment where an older adult can live an independent, healthy, and happy life.
| References|| |
[Figure 1], [Figure 2]