Effect of an ICOPE-Based Personalized Care Plan on Intrinsic Capacity and Wellbeing Among Older Adults: A Prospective Cohort Study

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This study evaluated the impact of an ICOPE-based personalized care plan over six months on IC and quality of life, measured using the WHO-5 Wellbeing Index. Methods A prospective cohort study was conducted among 135 individuals aged ≥60 years in a tertiary care setting. At baseline, IC was assessed using the ICOPE framework, and personalized care plans were developed to address IC deficits. Participants were reassessed after six months. Primary and secondary outcomes included changes in WHO-5 Wellbeing Index scores and the number of impaired IC domains, respectively. Results Of the 135 participants (mean age: 69 ± 5 years, 57% males), 107 (78%) completed follow-up. At baseline, 89% had at least one impaired IC domain, with vision (63%) and psychological capacity (44%) being the most affected. Over six months, the mean number of impaired IC domains decreased from 2.11 ± 0.94 to 1.33 ± 1.13 (p < 0.001), and WHO-5 Wellbeing Index scores improved significantly from 14.65 ± 4.38 to 17.98 ± 3.54 (p < 0.001). Conclusion ICOPE-based personalized care plans significantly improved IC and wellbeing among older adults. These findings highlight the potential of ICOPE interventions in geriatric care, warranting further validation through randomized controlled trials. Intrinsic capacity WHO ICOPE Healthy ageing integrated care older adults Figures Figure 1 INTRODUCTION The global population is rapidly ageing. Over the next three decades, the number of people aged 60 years and above is projected to double to 2.1 billion by 2050, accounting for 22% of the world’s population [ 1 ]. This demographic shift is unprecedented in human history and poses significant challenges for health systems worldwide. India is no exception—according to the India Ageing Report 2023, the older adult population in India is projected to increase from 149 million in 2022 (10.5%) to 347 million by 2050 (20.8%) [ 2 ]. In response to this demographic trend, the global health focus is shifting from a disease-based model to a function-based approach that supports older adults in maintaining independence and well-being [ 3 ]. The World Health Organization (WHO), in its World Report on Ageing and Health (2015), introduced the concept of healthy ageing, defined as the process of developing and maintaining functional ability that enables well-being in older age. Functional ability, in turn, depends on an individual’s intrinsic capacity (IC)—the composite of all physical and mental capacities—as well as their environment and the interaction between the two [ 3 ]. To operationalize this approach, WHO developed the Integrated Care for Older People (ICOPE) framework, which offers person-centred care pathways for identifying and managing declines in intrinsic capacity across six domains: cognition, psychological capacity, vitality, mobility, vision, and hearing. The overarching goal of ICOPE is to maintain or improve IC and functional ability to promote healthy ageing for all [ 3 ]. Several studies globally have validated the feasibility and diagnostic performance of the ICOPE screening tool. A cross-sectional pilot study from China demonstrated the utility of ICOPE Step 1 in identifying IC decline in community-dwelling older adults [ 10 ]. Similarly, data from the Multidomain Alzheimer Preventive Trial (MAPT) revealed that nearly 90% of older adults had one or more IC deficits [ 11 ]. The INSPIRE study in France further confirmed the feasibility of large-scale ICOPE implementation, with 94.3% of participants showing declines in IC during initial screening [ 14 ]. A global scoping review by Gobbens et al. [ 22 ] highlighted both the promise and the practical challenges of applying the ICOPE model across different healthcare systems, particularly in low- and middle-income countries (LMICs). A realist evaluation in India further emphasized the feasibility of adopting ICOPE’s function-focused approach but also noted that context-specific adaptations are needed to address structural and resource-related constraints [ 21 ]. While these studies support the use of ICOPE for screening and planning care in older adults, there is limited evidence on the longitudinal impact of ICOPE-based interventions on health outcomes such as intrinsic capacity and quality of life. This prospective study was conducted to address this gap. We evaluated the six-month impact of a personalized care plan guided by the ICOPE framework on intrinsic capacity and well-being, using the WHO-5 Wellbeing QoL Index as a primary outcome measure. MATERIALS & METHODS General study details : This prospective cohort study with the follow up of 6 months, conducted from October 2021 to September 2022, in the outpatient setting of the Department of Geriatric Medicine at All India Institute of Medical Sciences, New Delhi, India. Participants aged 60 years or older were enrolled after providing informed consent. A multidisciplinary team, including a geriatrician, ophthalmologist, ENT specialist, psychiatrist, psychologist, physiotherapist, and dietician, were involved in assessing participants and prescribing personalized care plans. The study received approval from the Institutional Ethics Committee of AIIMS, New Delhi (IEC reference number IECPG-153/24.02.2021) and adhered to the ethical guidelines of the Declaration of Helsinki. (Clinical trial number: not applicable) Participants The inclusion criteria for enrolment of participants were aged 60 years or above older adults attending geriatric medicine OPD and providing informed consent to participate in study. There are no specific exclusion criteria. Objectives: The primary objective of this study was to evaluate the impact of an ICOPE-based personalized care plan administered over six months to the older adults aged 60 years or above. The impact was measured by comparing the participants' quality of life before and after adopting the care plan. The WHO-5 Well-Being Index was used to assess quality of life. Study methodology: The participants were recruited based on the inclusion criteria mentioned above. After obtaining informed consent, all participants underwent WHO ICOPE Step 1 , which involved screening of all the domains of intrinsic capacity using the WHO ICOPE Screening Questionnaire during their first visit. Participants with impaired domains affecting their intrinsic capacity were identified in step 1 and they were further evaluated with step 2. In WHO ICOPE Step 2 , an in-depth assessment of the impaired domains of intrinsic capacity were conducted with confirmatory tools during the first visit. The quality of life was assessed at the first visit using the WHO-5 Well-Being Index , before giving care plan. Based on the assessment results, a personalized care plan was developed and provided to each participant, aimed at improving their impaired domains of intrinsic capacity. Other parameters assessed in first visit included functionality through the Barthel ADLs and Lawton IADLs scales, frailty using the FRAIL score , sarcopenia screening with the SARC-F score , socioeconomic status based on the modified Kuppuswamy scale , and comorbidity index assessed using the Charlson Comorbidity Index . (WHO ICOPE step 1 and step 2 are given in below Table 1 .) Table 1 step 1 and step 2 of WHO ICOPE approach IC Domains Step 1 Step 2 Cognitive Capacity Three-word registration: The three objects are: Flower, Door, Rice Orientation to time and place: Recall Interpretation- Fail if a person cannot answer one of the two questions about orientation OR cannot remember all three words, cognitive decline is likely present Clinical Dementia Rating (CDR) Scale Psychological Capacity In the past two weeks have you been bothered by a) Feeling down, depressed, or hopeless?or b) Little interest or pleasure in doing things? If Yes to any above, then further assessment is needed Patient Heath Questionnaire − 9 (PHQ9) Scale Vitality Have you unintentionally lost 3 kgs over the last three months? or Have you experienced loss of appetite? If Yes to any above then further assessment needed Mini Nutritional Assessment (MNA) Functional Capacity , “Do you think it would be safe for you to try to stand up from a chair five times without using your arms?” (Demonstrate to the person.) If YES, ask them to: – sit in the middle of the chair – cross and keep their arms over their chest – rise to a full standing position and then sit down again – repeat five times as quickly as possible without stopping. further assessment is needed if they cannot stand up five times within 14 seconds Short Physical Performance Battery (SPPB) Assessment Visual Capacity E- chart assessment Ophthalmologist assessment Hearing Capacity Whisper test ENT Specialist assessment including PTA assessment Personalised care-plan for impaired intrinsic capacity was given by multi-disciplinary team including geriatrician, ophthalmologist, ENT specialist, psychiatrist, psychologist, physiotherapist, and dietician for improving participants’ intrinsic capacity trajectory. All study participants were followed up in person after 6 months during their follow-up visit (Table 2 ). In follow-up visit, they were reassessed using WHO ICOPE Step 1 . If any impaired domain was identified, an in-depth assessment of that domain was conducted using WHO ICOPE Step 2 . The quality of life was also re-evaluated at the follow-up visit using the same tool, the WHO-5 Well-Being Index , post-intervention. The impact of the WHO ICOPE-based personalized care plan was assessed by evaluating changes in the individual's quality of life. Table 2 assessment done in first and follow-up visits Visits Assessments done First visit: o ICOPE step 1 screening of all 6 domains have been done by ICOPE screening protocol, followed by o ICOPE step 2 of in-depth assessment of impaired domains and then o WHO wellbeing score (assessing quality of life) was asked according to present state of patient (before care plan) o ICOPE step 3 i.e., personalised care plan was given based on deficit of the patient by treating physician. Follow-up visit (after 6 months): o Again, ICOPE step 1 screening of all 6 domains have been done by ICOPE screening protocol, followed by o ICOPE step 2 of in-depth assessment of impaired domains and then o WHO wellbeing score (assessing quality of life) was asked according to present state of patient (after care plan) STATISTICAL ANALYSIS This preliminary prospective study evaluated the impact of an ICOPE-based personalized care plan over six months. Due to the absence of prior studies evaluating the impact of ICOPE-based personalized interventions on intrinsic capacity and quality of life, convenience sampling was employed to recruit participants in this exploratory clinical setting. Data analysis was performed using STATA version 16.2. Categorical variables were summarized as frequencies and percentages, while continuous variables were described using measures such as mean, median, standard deviation, interquartile range, and range. The Shapiro-Wilk test assessed the normality of continuous data. Associations between categorical variables were analyzed using the Chi-square test or McNemar’s test for paired data. Changes in continuous variables before and after the intervention were compared using paired t-tests for normally distributed data and Wilcoxon signed-rank tests for non-normally distributed data. Statistical significance was set at a two-sided p-value of < 0.05. RESULTS A total of 135 individuals were recruited during the first visit, comprising 57% males and 43% females, with a mean age of 69 years (SD 5 years). Follow-up was completed for 107 participants (78%). At baseline, 59% of the cohort belonged to the lower socioeconomic class (Modified Kuppuswamy scale), 19% were frail (FRAIL score), and 6% screened positive for sarcopenia (SARC-F questionnaire). The median CCI score was 3 (IQR: 2–5), with 42% of participants reporting polypharmacy. The mean baseline WHO-5 Wellbeing Index score was 14.65 (SD 4.38). (Table 3 ) Table 3: Showing Baseline Characteristics of Study Population Sr no. Baseline characteristics of Study Population 1. Age (mean) 69 years (SD ±5) 2. Gender Male Female 77 (56%) 58 (43%) 3. Modified Kuppuswamy scale Lower class Lower middle class Upper middle class Upper Class 59 (43%) 17 (12%) 50 (37%) 9 (6%) 4. Barthel ADL preserved (7/7) 133 (99%) 5. Lawton I-ADL preserved 84 (62 %) 6. FRAIL score >3 26 (19%) 7. SARC-F (>4) 8 (6%) 8. CCI (medium) 3 (IQR:2 -5) 9. No. of Comorbidities (Medium) 2 (IQR:1-4) 10. Type of Co-morbities Diabetes Mellitus Hypertension Cardiovascular Diseases Anaemia Cerebrovascular Accidents Hypothyroidism 42 (31%) 78 (57%) 25 (18%) 7 (5 %) 5 (3.7%) 11 (8%) 11. Medium of number of medications 4 (IQR: 2-6) 12. Presence of Polypharmacy (> or equal to 5) 58 (42%) 13. Mean of WHO-5 well-being index 14.65 (SD 4.38) Visual capacity was the most commonly impaired domain (30%), followed by psychological (20%), cognitive (17%), locomotor (15%), hearing (10%), and vitality (8%). (Fig. 1). The most frequent causes of vision impairment were refractive errors, cataracts, and diabetic retinopathy. Overall, 89% of participants had at least one impaired domain or positive intrinsic capacity (IC) impairment based on ICOPE Step 1 screening. At follow-up, significant improvements were observed. The mean number of impaired IC domains decreased from 2.11 (SD 4.38) at baseline to 1.33 (SD 1.13) (p < 0.0001). Similarly, the WHO-5 Wellbeing Index score improved from a mean of 14.65 (SD 4.38) at baseline to 17.98 (SD 3.54) (p < 0.0001), indicating enhanced quality of life. Furthermore, the number of individuals with higher wellbeing scores (better QoL) increased significantly, demonstrating the positive impact of the personalized ICOPE-based care plan on intrinsic capacity and overall wellbeing. (Table 4 ) In Step 1 ICOPE screening, significant improvements were seen in psychological capacity, locomotor capacity, vitality, hearing capacity, and visual capacity. Additionally, in Step 2 ICOPE assessment, the mean PHQ-9 scale, mean MNA score, and mean SPPB score also improved significantly. However, cognitive capacity showed no improvement in either Step 1 or Step 2 results. These results demonstrate the effectiveness of the ICOPE-based care plan in improving intrinsic capacity and overall wellbeing among older adults. (Table 4 ) Table 4 Results of Step 1 and Step 2 ICOPE Assessment at first and follow-up visits. STEP 1 ICOPE SCREENING First Visit (107) Follow-up Visit (107) P-value Impaired Cognition capacity 41 (38%) 29 (27%) 0.22 Impaired Psychological capacity 50 (46%) 26 (24%) < 0.0001 Impaired Locomotor capacity 35 (33%) 30 (28%) 0.004 Impaired Vitality 17 (16%) 5 (4.6%) 0.0005 Impaired Hearing 20 (19%) 16 (15%) < 0.0001 Impaired Vision 69 (64%) 38 (36%) < 0.0001 No. of Impaired Domains (mean) 2.11 (SD 1.39) 1.33 (SD1.13) < 0.0001 WHO-5 well-being QoL Index (mean) 14.65 (SD 4.38) 17.98 (SD 3.54) < 0.0001 STEP 2 ICOPE IN-DEPTH ASSESSMENT CDR (median) 0.5 (IQR 0-0.5) 0.5 (IQR0-0.5) 1.00 PHQ-9 (mean) 9.58 (SD4.68) 10.48 (SD 4.17) 0.0005 MNA (mean) 18.61 (SD 2.61) 20.8 (SD3.03) 0.04 SPPB (mean) 7.38 (SD 1.99) 9.75 (SD 1.57) 0.0001 DISCUSSION Ageing is an inevitable and universal process that not only increases the risk of various chronic diseases but can also obscure emerging health issues. Older individuals often experience a decline in both physical and cognitive functions, yet these symptoms are frequently attributed to “normal ageing” by both individuals and society. This passive acceptance can delay timely intervention. Consequently, a conventional disease-centered model is insufficient to address the complex, multidimensional health needs of older adults. This underscores the necessity for an integrated, person-centered approach—such as the WHO’s Integrated Care for Older People (ICOPE) framework—aimed at optimizing intrinsic capacity (IC) to achieve healthy ageing. Several studies globally have validated the feasibility and utility of the ICOPE screening tool. In Korea, the ICOOP_Frail study demonstrated its applicability in primary care for detecting IC decline among frail older adults [ 12 ]. Similarly, Xu et al. validated the ICOPE Step 1 screening tool in China, showing its reliability for early identification of functional decline [ 13 ]. In France, large-scale studies like INSPIRE [ 14 ] and MAPT [ 15 ] highlighted the practicality of integrating ICOPE into population-based screening, with a high prevalence of IC impairments detected. Moreover, the ICOPE digital application has shown promise in enhancing accessibility and standardization of IC assessments [ 15 ]. Building on this, recent studies have expanded the evidence base for ICOPE implementation. Lu et al. in China reported a sensitivity of 89.5% and specificity of 57.1% for Step 1 screening, affirming its value as a community-level triage tool [ 16 ]. Similarly, the VIMCI study in Spain by Rojano i Luque et al. found high sensitivity (93.3%) but lower specificity (43.2%), underscoring its role in case-finding [ 17 ]. In Hong Kong, Leung et al. observed IC decline in 68.8% of community-dwelling older adults, with mobility and vision most frequently impaired [ 18 ]. Lin et al. from Western China linked reduced geographical access to increased demand for ICOPE, highlighting how social determinants impact service utilization [ 19 ]. In Taiwan, Su et al. successfully adapted and validated the ICOPE screening tool (ICOPES-TW), confirming strong reliability and construct validity [ 20 ]. Despite this global momentum, most studies have focused on feasibility and cross-sectional assessments, rather than evaluating the longitudinal impact of ICOPE-based interventions on health outcomes. Our study addresses this gap by prospectively assessing the effect of an ICOPE-guided personalised care plan over six months, using WHO-5 Wellbeing Index as a measure of quality of life in a real-world clinical setting. We enrolled 135 participants (mean age 69 years), with 107 completing follow-up (79%). During baseline ICOPE Step 1 screening, 89% of participants had at least one impaired domain. This high prevalence is consistent with clinical cohorts and mirrors findings from the INSPIRE study, which reported a 94% impairment rate, albeit in an older population (mean age 76 years) [ 14 ]. In our cohort, the most affected domain was vision (30%), followed by psychological (20%), cognitive (17%), locomotor (15%), hearing (10%), and vitality (8%). The majority of vision impairments were due to reversible causes such as refractive errors, cataracts, and diabetic retinopathy—highlighting an opportunity for targeted interventions to improve quality of life. Similarly, other domain impairments were linked to common geriatric syndromes such as osteoarthritis, depression, malnutrition, presbycusis, and Alzheimer’s disease. Unlike the INSPIRE study, our design included Step 2 assessments at both visits, allowing for deeper insight into functional change. We observed significant improvements across all domains except cognition, where change may require a longer follow-up period. The mean number of impaired domains reduced from 2.11 to 1.33 (p < 0.0001), and WHO-5 scores improved significantly (14.65 to 17.98, p < 0.0001), indicating that ICOPE-guided care can measurably enhance intrinsic capacity and well-being. Our findings align with longitudinal studies that have shown IC to be a strong predictor of adverse outcomes such as disability, hospitalization, and mortality [ 21 ], reinforcing the importance of early intervention. Additionally, a recent realist evaluation on ICOPE implementation in India acknowledged its feasibility, while stressing the need for context-specific adaptations due to structural and system-level constraints [ 25 ]. Looking forward, digital innovations like the ICOPE app offer opportunities for broader scale-up and monitoring. Early experiences from the INSPIRE-T study in France suggest that such tools can enhance follow-up, data capture, and care continuity, especially in primary care settings [ 23 ]. Furthermore, task-shifting models such as nurse-led ICOPE delivery have shown promise in rural France and could be explored in resource-constrained Indian settings [ 24 ]. The strengths of our study include its prospective design, high follow-up rate, use of validated tools (WHO-5, ICOPE Step 2), and the multidisciplinary care model, making it among the first in India to assess the real-world impact of personalized ICOPE care. However, limitations include a modest sample size, single-center urban setting, and lack of representation from rural or institutionalized populations. This study contributes important evidence supporting the integration of the ICOPE model into geriatric practice in India, particularly through function-focused, multidisciplinary approaches. As India prepares for a doubling of its elderly population by 2050, models like ICOPE—aligned with the WHO Decade of Healthy Ageing (2021–2030)—can serve as valuable blueprints for delivering high-value, person-centered care. CONCLUSION The ICOPE-based personalized care plan significantly improved intrinsic capacity and wellbeing in older adults over six months. Most impairments were reversible and responded well to targeted interventions. These findings support the integration of function-focused, multidisciplinary care models like ICOPE into routine geriatric practice to promote healthy ageing. Abbreviations Integrated care of older people (ICOPE); Intrinsic Capacity (IC), World Health Organisation (WHO), Quality of Life (QoL), Patient Health Questionnaire (PHQ-9), Mini-Nutritional Assessment (MNA), Short Physical Performance Battery (SPPB). Declarations Ethics approval- The study received approval from the Institutional Ethics Committee of AIIMS, New Delhi (IEC reference number IECPG-153/24.02.2021) and adhered to the ethical guidelines of the Declaration of Helsinki. Consent for Participation- Written informed consent for participation was obtained from all participants prior to their inclusion in the study. Consent for publication- Written informed consent for publication was obtained from each participant. Availability of data and materials- Available upon request, contact corresponding author. Competing interests- The authors declare no competing interests . Funding- This study received no external funding Clinical trial number: not applicable Authors' contributions Parul Bhutani- Involves in designing and writing protocol, recruitment of subjects, data collections at first and follow up visit, writing the manuscript Prasun Chatterjee- Involves in designing the protocol, proof reading of protocol, collaborating with multidisciplinary team, proof reading of manuscript Avinash Chakrawarty- Involves in designing the protocol, proof reading of protocol, collaborating with multidisciplinary team, proof reading of manuscript M A Khan- Data analysis and result interpretation Ruchika Madan- providing Individualised intervention for mobility at first and follow up visit, proof reading of manuscript Acknowledgement : I would like to express my profound gratitude to Mr. Pankaj Kumar Bhutani, Mr. Bhasker Taneja, Dr. Rajneesh Bhutani, and Mr. Vedanta Krishna Bhutani for their unwavering support, motivation, and persistent guidance throughout the completion of this research and the writing of this paper. I am also deeply grateful to Dr. Prasun Chatterjee, Dr. Meenal, Dr. Akshata Rao, and Dr. Abhijeet for their invaluable expertise, insightful suggestions, and constructive feedback, which have been instrumental in shaping this work. Their constant encouragement has not only helped me overcome challenges but has also strengthened my determination to complete this study with precision and clarity. I sincerely appreciate their time, effort, and invaluable contributions to this research paper. References United Nations Population Fund (UNFPA), International Institute for Population Sciences (IIPS). India Ageing Report 2023 . New Delhi: UNFPA India; 2023. World Health Organization. World report on ageing and health [Internet]. Geneva: World Health Organization; 2015 [cited 2025 May 31]. Available from: https://apps.who.int/iris/handle/10665/186463 World Health Organization. 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BMC Geriatr. 2022;22:812. https://doi.org/10.1186/s12877-022-03450-y González-Bautista E, Barreto PD, Virecoulon Giudici K, et al. Intrinsic capacity predicts negative health outcomes in older adults: A 2-year longitudinal study. J Gerontol A Biol Sci Med Sci. 2021;76(5):905–912. https://doi.org/10.1093/gerona/glaa295 Zulfiqar T, Hajjam M, Tavassoli N, et al. Nurse-led integrated care for older people in rural France: an evaluation of ICOPE implementation. BMC Nurs. 2023;22:18. https://doi.org/10.1186/s12912-023-00944-2 de Kerimel J, Tavassoli N, Lafont C, et al. Implementation of WHO ICOPE digital tools in primary care: Lessons from INSPIRE-T. J Frailty Aging. 2022;11(5):520–525. https://doi.org/10.14283/jfa.2022.33 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 08 Sep, 2025 Reviewers invited by journal 03 Sep, 2025 Editor invited by journal 11 Aug, 2025 Editor assigned by journal 08 Aug, 2025 Submission checks completed at journal 08 Aug, 2025 First submitted to journal 29 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7241838","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":511694130,"identity":"ef950a3d-f667-4456-88ac-04b73884fe83","order_by":0,"name":"Parul Bhutani","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFUlEQVRIie2PMUvDQBTHI4V2SbhNXhHbr/AkYFPww9xb6lLEMZPcVJdI1xY/gotwELJ5IWtC1xMddMlUwdKlQweToJNJdBS83/Iex//H/51lGQx/lVehqqk2e7BZufHLHxQqFLuY8VJ4g74oFfyl0nGE72LV2KKMelkOFD3TQy+LlRMBydUdvb+gNWSHqlYZB+enQGlOgX3BVT8FCvWbhOKwk+Utr1VQTbpAs4QCa4oKu6WS3ZcKx6cGZZV/KmyNihe7XGRy16rorxYoWuIZuMhuwtaW8SLveJQmbqDXGIsUBqCd0OMIjX8ZscmB3kTJ8fV86m73/pXN5pl83PlnQ3bUcNj3J6iSUBtvUJhqTBsMBsP/5AMHZWtTWIpNqAAAAABJRU5ErkJggg==","orcid":"","institution":"All India Institute of Medical Sciences Rishikesh","correspondingAuthor":true,"prefix":"","firstName":"Parul","middleName":"","lastName":"Bhutani","suffix":""},{"id":511694131,"identity":"dd9c8d84-88e3-409e-97d9-61d1e7918da6","order_by":1,"name":"Prasun Chatterjee","email":"","orcid":"","institution":"All India Institute of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Prasun","middleName":"","lastName":"Chatterjee","suffix":""},{"id":511694132,"identity":"52e86df6-8174-429b-949b-46edd944eb68","order_by":2,"name":"Avinash Chakrawarty","email":"","orcid":"","institution":"All India Institute of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Avinash","middleName":"","lastName":"Chakrawarty","suffix":""},{"id":511694133,"identity":"983431d7-7be3-4e2d-942f-bae60e217f23","order_by":3,"name":"M A Khan","email":"","orcid":"","institution":"All India Institute of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"M","middleName":"A","lastName":"Khan","suffix":""},{"id":511694134,"identity":"28eab621-1ffa-4af7-bb20-5949f649e201","order_by":4,"name":"R Madan","email":"","orcid":"","institution":"All India Institute of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"R","middleName":"","lastName":"Madan","suffix":""}],"badges":[],"createdAt":"2025-07-29 09:53:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7241838/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7241838/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91022627,"identity":"93364a3c-1842-49d6-87c4-54684d6d8ecd","added_by":"auto","created_at":"2025-09-10 19:05:47","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":34598,"visible":true,"origin":"","legend":"\u003cp\u003ePie chart showing distribution of impaired domains of intrinsic capacity in ICOPE step 1 screening.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7241838/v1/8cb2516c35f3171175ced101.png"},{"id":91023337,"identity":"13082e0e-7c8a-4867-808f-22ec0f7476d3","added_by":"auto","created_at":"2025-09-10 19:13:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":756790,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7241838/v1/a9caac1e-006a-466e-b57e-3070555eca3b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of an ICOPE-Based Personalized Care Plan on Intrinsic Capacity and Wellbeing Among Older Adults: A Prospective Cohort Study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eThe global population is rapidly ageing. Over the next three decades, the number of people aged 60 years and above is projected to double to 2.1\u0026nbsp;billion by 2050, accounting for 22% of the world\u0026rsquo;s population [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This demographic shift is unprecedented in human history and poses significant challenges for health systems worldwide. India is no exception\u0026mdash;according to the India Ageing Report 2023, the older adult population in India is projected to increase from 149\u0026nbsp;million in 2022 (10.5%) to 347\u0026nbsp;million by 2050 (20.8%) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn response to this demographic trend, the global health focus is shifting from a disease-based model to a function-based approach that supports older adults in maintaining independence and well-being [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The World Health Organization (WHO), in its \u003cem\u003eWorld Report on Ageing and Health\u003c/em\u003e (2015), introduced the concept of healthy ageing, defined as the process of developing and maintaining functional ability that enables well-being in older age. Functional ability, in turn, depends on an individual\u0026rsquo;s intrinsic capacity (IC)\u0026mdash;the composite of all physical and mental capacities\u0026mdash;as well as their environment and the interaction between the two [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTo operationalize this approach, WHO developed the Integrated Care for Older People (ICOPE) framework, which offers person-centred care pathways for identifying and managing declines in intrinsic capacity across six domains: cognition, psychological capacity, vitality, mobility, vision, and hearing. The overarching goal of ICOPE is to maintain or improve IC and functional ability to promote healthy ageing for all [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSeveral studies globally have validated the feasibility and diagnostic performance of the ICOPE screening tool. A cross-sectional pilot study from China demonstrated the utility of ICOPE Step 1 in identifying IC decline in community-dwelling older adults [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Similarly, data from the Multidomain Alzheimer Preventive Trial (MAPT) revealed that nearly 90% of older adults had one or more IC deficits [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The INSPIRE study in France further confirmed the feasibility of large-scale ICOPE implementation, with 94.3% of participants showing declines in IC during initial screening [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA global scoping review by Gobbens et al. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] highlighted both the promise and the practical challenges of applying the ICOPE model across different healthcare systems, particularly in low- and middle-income countries (LMICs). A realist evaluation in India further emphasized the feasibility of adopting ICOPE\u0026rsquo;s function-focused approach but also noted that context-specific adaptations are needed to address structural and resource-related constraints [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWhile these studies support the use of ICOPE for screening and planning care in older adults, there is limited evidence on the longitudinal impact of ICOPE-based interventions on health outcomes such as intrinsic capacity and quality of life. This prospective study was conducted to address this gap. We evaluated the six-month impact of a personalized care plan guided by the ICOPE framework on intrinsic capacity and well-being, using the WHO-5 Wellbeing QoL Index as a primary outcome measure.\u003c/p\u003e"},{"header":"MATERIALS \u0026 METHODS","content":"\u003cp\u003e\u003cb\u003eGeneral study details\u003c/b\u003e: This prospective cohort study with the follow up of 6 months, conducted from October 2021 to September 2022, in the outpatient setting of the Department of Geriatric Medicine at All India Institute of Medical Sciences, New Delhi, India. Participants aged 60 years or older were enrolled after providing informed consent. A multidisciplinary team, including a geriatrician, ophthalmologist, ENT specialist, psychiatrist, psychologist, physiotherapist, and dietician, were involved in assessing participants and prescribing personalized care plans. The study received approval from the Institutional Ethics Committee of AIIMS, New Delhi (IEC reference number IECPG-153/24.02.2021) and adhered to the ethical guidelines of the Declaration of Helsinki. (Clinical trial number: not applicable)\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003cp\u003eThe inclusion criteria for enrolment of participants were aged 60 years or above older adults attending geriatric medicine OPD and providing informed consent to participate in study. There are no specific exclusion criteria.\u003c/p\u003e\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eObjectives:\u003c/h2\u003e\u003cp\u003eThe primary objective of this study was to evaluate the impact of an ICOPE-based personalized care plan administered over six months to the older adults aged 60 years or above. The impact was measured by comparing the participants' quality of life before and after adopting the care plan. The WHO-5 Well-Being Index was used to assess quality of life.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy methodology:\u003c/h3\u003e\n\u003cp\u003eThe participants were recruited based on the inclusion criteria mentioned above. After obtaining informed consent, all participants underwent \u003cb\u003eWHO ICOPE Step 1\u003c/b\u003e, which involved screening of all the domains of intrinsic capacity using the WHO ICOPE Screening Questionnaire during their first visit. Participants with impaired domains affecting their intrinsic capacity were identified in step 1 and they were further evaluated with step 2. In \u003cb\u003eWHO ICOPE Step 2\u003c/b\u003e, an in-depth assessment of the impaired domains of intrinsic capacity were conducted with confirmatory tools during the first visit. The quality of life was assessed at the first visit using the \u003cb\u003eWHO-5 Well-Being Index\u003c/b\u003e, before giving care plan. Based on the assessment results, a personalized care plan was developed and provided to each participant, aimed at improving their impaired domains of intrinsic capacity. Other parameters assessed in first visit included functionality through the \u003cb\u003eBarthel ADLs\u003c/b\u003e and \u003cb\u003eLawton IADLs\u003c/b\u003e scales, frailty using the \u003cb\u003eFRAIL score\u003c/b\u003e, sarcopenia screening with the \u003cb\u003eSARC-F score\u003c/b\u003e, socioeconomic status based on the \u003cb\u003emodified Kuppuswamy scale\u003c/b\u003e, and comorbidity index assessed using the \u003cb\u003eCharlson Comorbidity Index\u003c/b\u003e.\u003c/p\u003e\u003cp\u003e(WHO ICOPE step 1 and step 2 are given in below Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003estep 1 and step 2 of WHO ICOPE approach\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIC Domains\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStep 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStep 2\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCognitive Capacity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThree-word registration: The three objects are: Flower, Door, Rice\u003c/p\u003e\u003cp\u003eOrientation to time and place:\u003c/p\u003e\u003cp\u003eRecall\u003c/p\u003e\u003cp\u003eInterpretation- Fail if a person cannot answer one of the two questions about orientation OR cannot remember all three words, cognitive decline is likely present\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eClinical Dementia Rating (CDR) Scale\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychological Capacity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIn the past two weeks have you been bothered by\u003c/p\u003e\u003cp\u003ea) Feeling down, depressed, or hopeless?or\u003c/p\u003e\u003cp\u003eb) Little interest or pleasure in doing things?\u003c/p\u003e\u003cp\u003eIf Yes to any above, then further assessment is needed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePatient Heath Questionnaire \u0026minus;\u0026thinsp;9 (PHQ9) Scale\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVitality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHave you unintentionally lost 3 kgs over the last three months?\u003c/p\u003e\u003cp\u003eor\u003c/p\u003e\u003cp\u003eHave you experienced loss of appetite?\u003c/p\u003e\u003cp\u003eIf Yes to any above then further assessment needed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMini Nutritional Assessment (MNA)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFunctional Capacity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e, \u0026ldquo;Do you think it would be safe for you to try to stand up from a chair five times without using your arms?\u0026rdquo;\u003c/p\u003e\u003cp\u003e(Demonstrate to the person.)\u003c/p\u003e\u003cp\u003eIf YES, ask them to:\u003c/p\u003e\u003cp\u003e\u0026ndash; sit in the middle of the chair\u003c/p\u003e\u003cp\u003e\u0026ndash; cross and keep their arms over their chest\u003c/p\u003e\u003cp\u003e\u0026ndash; rise to a full standing position and then sit down again\u003c/p\u003e\u003cp\u003e\u0026ndash; repeat five times as quickly as possible without stopping.\u003c/p\u003e\u003cp\u003efurther assessment is needed if they cannot stand up five times within 14 seconds\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eShort Physical Performance Battery (SPPB) Assessment\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVisual Capacity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eE- chart assessment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOphthalmologist assessment\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHearing Capacity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWhisper test\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eENT Specialist assessment including PTA assessment\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003ePersonalised care-plan for impaired intrinsic capacity was given by multi-disciplinary team including geriatrician, ophthalmologist, ENT specialist, psychiatrist, psychologist, physiotherapist, and dietician for improving participants\u0026rsquo; intrinsic capacity trajectory.\u003c/p\u003e\u003cp\u003eAll study participants were followed up in person after 6 months during their follow-up visit (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). In follow-up visit, they were reassessed using \u003cb\u003eWHO ICOPE Step 1\u003c/b\u003e. If any impaired domain was identified, an in-depth assessment of that domain was conducted using \u003cb\u003eWHO ICOPE Step 2\u003c/b\u003e. The quality of life was also re-evaluated at the follow-up visit using the same tool, the \u003cb\u003eWHO-5 Well-Being Index\u003c/b\u003e, post-intervention. The impact of the WHO ICOPE-based personalized care plan was assessed by evaluating changes in the individual's quality of life.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eassessment done in first and follow-up visits\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVisits\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAssessments done\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFirst visit:\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eo ICOPE step 1 screening of all 6 domains have been done by ICOPE screening protocol, followed by\u003c/p\u003e\u003cp\u003eo ICOPE step 2 of in-depth assessment of impaired domains and then\u003c/p\u003e\u003cp\u003eo WHO wellbeing score (assessing quality of life) was asked according to present state of patient (before care plan)\u003c/p\u003e\u003cp\u003eo ICOPE step 3 i.e., personalised care plan was given based on deficit of the patient by treating physician.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFollow-up visit (after 6 months):\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eo Again, ICOPE step 1 screening of all 6 domains have been done by ICOPE screening protocol, followed by\u003c/p\u003e\u003cp\u003eo ICOPE step 2 of in-depth assessment of impaired domains and then\u003c/p\u003e\u003cp\u003eo WHO wellbeing score (assessing quality of life) was asked according to present state of patient (after care plan)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eSTATISTICAL ANALYSIS\u003c/h2\u003e\u003cp\u003eThis preliminary prospective study evaluated the impact of an ICOPE-based personalized care plan over six months. Due to the absence of prior studies evaluating the impact of ICOPE-based personalized interventions on intrinsic capacity and quality of life, convenience sampling was employed to recruit participants in this exploratory clinical setting. Data analysis was performed using STATA version 16.2. Categorical variables were summarized as frequencies and percentages, while continuous variables were described using measures such as mean, median, standard deviation, interquartile range, and range. The Shapiro-Wilk test assessed the normality of continuous data. Associations between categorical variables were analyzed using the Chi-square test or McNemar\u0026rsquo;s test for paired data. Changes in continuous variables before and after the intervention were compared using paired t-tests for normally distributed data and Wilcoxon signed-rank tests for non-normally distributed data. Statistical significance was set at a two-sided p-value of \u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 135 individuals were recruited during the first visit, comprising 57% males and 43% females, with a mean age of 69 years (SD 5 years). Follow-up was completed for 107 participants (78%). At baseline, 59% of the cohort belonged to the lower socioeconomic class (Modified Kuppuswamy scale), 19% were frail (FRAIL score), and 6% screened positive for sarcopenia (SARC-F questionnaire). The median CCI score was 3 (IQR: 2\u0026ndash;5), with 42% of participants reporting polypharmacy. The mean baseline WHO-5 Wellbeing Index score was 14.65 (SD 4.38). (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\n\u003cp\u003eTable 3: Showing Baseline Characteristics of Study Population\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSr no.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline characteristics of Study Population\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eAge (mean)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e69 years (SD \u0026plusmn;5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e77 (56%)\u003c/p\u003e\n \u003cp\u003e58 (43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eModified Kuppuswamy scale\u003c/p\u003e\n \u003cp\u003eLower class\u003c/p\u003e\n \u003cp\u003eLower middle class\u003c/p\u003e\n \u003cp\u003eUpper middle class\u003c/p\u003e\n \u003cp\u003eUpper Class\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e59 (43%)\u003c/p\u003e\n \u003cp\u003e17 (12%)\u003c/p\u003e\n \u003cp\u003e50 (37%)\u003c/p\u003e\n \u003cp\u003e9 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eBarthel ADL preserved (7/7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e133 (99%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eLawton I-ADL preserved\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e84 (62 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eFRAIL score \u0026gt;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e26 (19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eSARC-F (\u0026gt;4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e8 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e8.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eCCI (medium)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e3 (IQR:2 -5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eNo. of Comorbidities (Medium)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e2 (IQR:1-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e10.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eType of Co-morbities\u003c/p\u003e\n \u003cp\u003eDiabetes Mellitus\u003c/p\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003cp\u003eCardiovascular Diseases\u003c/p\u003e\n \u003cp\u003eAnaemia\u003c/p\u003e\n \u003cp\u003eCerebrovascular Accidents\u003c/p\u003e\n \u003cp\u003eHypothyroidism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e42 (31%)\u003c/p\u003e\n \u003cp\u003e78 (57%)\u003c/p\u003e\n \u003cp\u003e25 (18%)\u003c/p\u003e\n \u003cp\u003e7 (5 %)\u003c/p\u003e\n \u003cp\u003e5 (3.7%)\u003c/p\u003e\n \u003cp\u003e11 (8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e11.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eMedium of number of medications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e4 (IQR: 2-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e12.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003ePresence of Polypharmacy (\u0026gt; or equal to 5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e58 (42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e13.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eMean of WHO-5 well-being index\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e14.65 (SD 4.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cdiv class=\"gridtable\"\u003e\u003c/div\u003e\n\u003cp\u003eVisual capacity was the most commonly impaired domain (30%), followed by psychological (20%), cognitive (17%), locomotor (15%), hearing (10%), and vitality (8%). (Fig. 1). The most frequent causes of vision impairment were refractive errors, cataracts, and diabetic retinopathy.\u003c/p\u003e\n\u003cp\u003eOverall, 89% of participants had at least one impaired domain or positive intrinsic capacity (IC) impairment based on ICOPE Step 1 screening.\u003c/p\u003e\n\u003cp\u003eAt follow-up, significant improvements were observed. The mean number of impaired IC domains decreased from 2.11 (SD 4.38) at baseline to 1.33 (SD 1.13) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Similarly, the WHO-5 Wellbeing Index score improved from a mean of 14.65 (SD 4.38) at baseline to 17.98 (SD 3.54) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), indicating enhanced quality of life. Furthermore, the number of individuals with higher wellbeing scores (better QoL) increased significantly, demonstrating the positive impact of the personalized ICOPE-based care plan on intrinsic capacity and overall wellbeing. (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\n\u003cp\u003eIn Step 1 ICOPE screening, significant improvements were seen in psychological capacity, locomotor capacity, vitality, hearing capacity, and visual capacity. Additionally, in Step 2 ICOPE assessment, the mean PHQ-9 scale, mean MNA score, and mean SPPB score also improved significantly. However, cognitive capacity showed no improvement in either Step 1 or Step 2 results. These results demonstrate the effectiveness of the ICOPE-based care plan in improving intrinsic capacity and overall wellbeing among older adults. (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eResults of Step 1 and Step 2 ICOPE Assessment at first and follow-up visits.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSTEP 1 ICOPE SCREENING\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFirst Visit (107)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFollow-up Visit (107)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImpaired Cognition capacity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41 (38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29 (27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImpaired Psychological capacity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50 (46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26 (24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImpaired Locomotor capacity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35 (33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30 (28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImpaired Vitality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17 (16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (4.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.0005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImpaired Hearing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16 (15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImpaired Vision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69 (64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38 (36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo. of Impaired Domains (mean)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.11 (SD 1.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.33 (SD1.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWHO-5 well-being QoL Index (mean)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.65 (SD 4.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.98 (SD 3.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eSTEP 2 ICOPE IN-DEPTH ASSESSMENT\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCDR (median)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.5 (IQR 0-0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.5 (IQR0-0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePHQ-9 (mean)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.58 (SD4.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.48 (SD 4.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.0005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMNA (mean)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.61 (SD 2.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.8 (SD3.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSPPB (mean)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.38 (SD 1.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.75 (SD 1.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eAgeing is an inevitable and universal process that not only increases the risk of various chronic diseases but can also obscure emerging health issues. Older individuals often experience a decline in both physical and cognitive functions, yet these symptoms are frequently attributed to \u0026ldquo;normal ageing\u0026rdquo; by both individuals and society. This passive acceptance can delay timely intervention. Consequently, a conventional disease-centered model is insufficient to address the complex, multidimensional health needs of older adults. This underscores the necessity for an integrated, person-centered approach\u0026mdash;such as the WHO\u0026rsquo;s Integrated Care for Older People (ICOPE) framework\u0026mdash;aimed at optimizing intrinsic capacity (IC) to achieve healthy ageing.\u003c/p\u003e\u003cp\u003eSeveral studies globally have validated the feasibility and utility of the ICOPE screening tool. In Korea, the ICOOP_Frail study demonstrated its applicability in primary care for detecting IC decline among frail older adults [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Similarly, Xu et al. validated the ICOPE Step 1 screening tool in China, showing its reliability for early identification of functional decline [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In France, large-scale studies like INSPIRE [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] and MAPT [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] highlighted the practicality of integrating ICOPE into population-based screening, with a high prevalence of IC impairments detected. Moreover, the ICOPE digital application has shown promise in enhancing accessibility and standardization of IC assessments [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eBuilding on this, recent studies have expanded the evidence base for ICOPE implementation. Lu et al. in China reported a sensitivity of 89.5% and specificity of 57.1% for Step 1 screening, affirming its value as a community-level triage tool [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Similarly, the VIMCI study in Spain by Rojano i Luque et al. found high sensitivity (93.3%) but lower specificity (43.2%), underscoring its role in case-finding [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In Hong Kong, Leung et al. observed IC decline in 68.8% of community-dwelling older adults, with mobility and vision most frequently impaired [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Lin et al. from Western China linked reduced geographical access to increased demand for ICOPE, highlighting how social determinants impact service utilization [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In Taiwan, Su et al. successfully adapted and validated the ICOPE screening tool (ICOPES-TW), confirming strong reliability and construct validity [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite this global momentum, most studies have focused on feasibility and cross-sectional assessments, rather than evaluating the longitudinal impact of ICOPE-based interventions on health outcomes. Our study addresses this gap by prospectively assessing the effect of an ICOPE-guided personalised care plan over six months, using WHO-5 Wellbeing Index as a measure of quality of life in a real-world clinical setting.\u003c/p\u003e\u003cp\u003eWe enrolled 135 participants (mean age 69 years), with 107 completing follow-up (79%). During baseline ICOPE Step 1 screening, 89% of participants had at least one impaired domain. This high prevalence is consistent with clinical cohorts and mirrors findings from the INSPIRE study, which reported a 94% impairment rate, albeit in an older population (mean age 76 years) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn our cohort, the most affected domain was vision (30%), followed by psychological (20%), cognitive (17%), locomotor (15%), hearing (10%), and vitality (8%). The majority of vision impairments were due to reversible causes such as refractive errors, cataracts, and diabetic retinopathy\u0026mdash;highlighting an opportunity for targeted interventions to improve quality of life. Similarly, other domain impairments were linked to common geriatric syndromes such as osteoarthritis, depression, malnutrition, presbycusis, and Alzheimer\u0026rsquo;s disease.\u003c/p\u003e\u003cp\u003eUnlike the INSPIRE study, our design included Step 2 assessments at both visits, allowing for deeper insight into functional change. We observed significant improvements across all domains except cognition, where change may require a longer follow-up period. The mean number of impaired domains reduced from 2.11 to 1.33 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), and WHO-5 scores improved significantly (14.65 to 17.98, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), indicating that ICOPE-guided care can measurably enhance intrinsic capacity and well-being.\u003c/p\u003e\u003cp\u003eOur findings align with longitudinal studies that have shown IC to be a strong predictor of adverse outcomes such as disability, hospitalization, and mortality [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], reinforcing the importance of early intervention. Additionally, a recent realist evaluation on ICOPE implementation in India acknowledged its feasibility, while stressing the need for context-specific adaptations due to structural and system-level constraints [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eLooking forward, digital innovations like the ICOPE app offer opportunities for broader scale-up and monitoring. Early experiences from the INSPIRE-T study in France suggest that such tools can enhance follow-up, data capture, and care continuity, especially in primary care settings [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Furthermore, task-shifting models such as nurse-led ICOPE delivery have shown promise in rural France and could be explored in resource-constrained Indian settings [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe strengths of our study include its prospective design, high follow-up rate, use of validated tools (WHO-5, ICOPE Step 2), and the multidisciplinary care model, making it among the first in India to assess the real-world impact of personalized ICOPE care. However, limitations include a modest sample size, single-center urban setting, and lack of representation from rural or institutionalized populations.\u003c/p\u003e\u003cp\u003eThis study contributes important evidence supporting the integration of the ICOPE model into geriatric practice in India, particularly through function-focused, multidisciplinary approaches. As India prepares for a doubling of its elderly population by 2050, models like ICOPE\u0026mdash;aligned with the WHO Decade of Healthy Ageing (2021\u0026ndash;2030)\u0026mdash;can serve as valuable blueprints for delivering high-value, person-centered care.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe ICOPE-based personalized care plan significantly improved intrinsic capacity and wellbeing in older adults over six months. Most impairments were reversible and responded well to targeted interventions. These findings support the integration of function-focused, multidisciplinary care models like ICOPE into routine geriatric practice to promote healthy ageing.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eIntegrated care of older people (ICOPE); Intrinsic Capacity (IC), World Health Organisation (WHO), Quality of Life (QoL), Patient Health Questionnaire (PHQ-9), Mini-Nutritional Assessment (MNA), Short Physical Performance Battery (SPPB).\u003c/p\u003e"},{"header":"Declarations","content":"\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eEthics approval-\u0026nbsp;\u003c/strong\u003eThe study received approval from the Institutional Ethics Committee of AIIMS, New Delhi (IEC reference number IECPG-153/24.02.2021) and adhered to the ethical guidelines of the Declaration of Helsinki.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eConsent for Participation-\u003c/strong\u003e Written informed consent for participation was obtained from all participants prior to their inclusion in the study.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eConsent for publication-\u0026nbsp;\u003c/strong\u003eWritten informed consent for publication was obtained from each participant.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAvailability of data and materials-\u0026nbsp;\u003c/strong\u003eAvailable upon request, contact corresponding author.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCompeting interests-\u0026nbsp;\u003c/strong\u003eThe authors declare no competing interests\u003cstrong\u003e.\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eFunding-\u0026nbsp;\u003c/strong\u003eThis study received no external funding\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e not applicable\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAuthors' contributions\u003cbr\u003e\u0026nbsp;\u003c/strong\u003eParul Bhutani- Involves in designing and writing protocol, recruitment of subjects, data collections at first and follow up visit, writing the manuscript\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003ePrasun Chatterjee- Involves in designing the protocol, proof reading of protocol, collaborating with multidisciplinary team, proof reading of manuscript\u003c/p\u003e\n\u003cp\u003eAvinash Chakrawarty- Involves in designing the protocol, proof reading of protocol, collaborating with multidisciplinary team, proof reading of manuscript\u003c/p\u003e\n\u003cp\u003eM A Khan- Data analysis and result interpretation\u003c/p\u003e\n\u003cp\u003eRuchika Madan- providing Individualised intervention for mobility at first and follow up visit, proof reading of manuscript\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e: I would like to express my profound gratitude to Mr. Pankaj Kumar Bhutani, Mr. Bhasker Taneja, Dr. Rajneesh Bhutani, and Mr. Vedanta Krishna Bhutani for their unwavering support, motivation, and persistent guidance throughout the completion of this research and the writing of this paper. I am also deeply grateful to Dr. Prasun Chatterjee, Dr. Meenal, Dr. Akshata Rao, and Dr. Abhijeet for their invaluable expertise, insightful suggestions, and constructive feedback, which have been instrumental in shaping this work. Their constant encouragement has not only helped me overcome challenges but has also strengthened my determination to complete this study with precision and clarity. I sincerely appreciate their time, effort, and invaluable contributions to this research paper.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eUnited Nations Population Fund (UNFPA), International Institute for Population Sciences (IIPS). \u003cem\u003eIndia Ageing Report 2023\u003c/em\u003e. New Delhi: UNFPA India; 2023.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. \u003cem\u003eWorld report on ageing and health\u003c/em\u003e [Internet]. Geneva: World Health Organization; 2015 [cited 2025 May 31]. Available from: https://apps.who.int/iris/handle/10665/186463\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. \u003cem\u003eIntegrated care for older people (ICOPE): Guidance for person-centred assessment and pathways in primary care\u003c/em\u003e [Internet]. Geneva: World Health Organization; 2019 [cited 2025 May 31]. Available from: https://apps.who.int/iris/bitstream/handle/10665/326843/WHO-FWC-ALC-19.1-eng.pdf?sequence=17\u003c/li\u003e\n\u003cli\u003eCesari M, Araujo de Carvalho I, Thiyagarajan JA, Cooper C, Martin FC, Reginster JY, Vellas B, Beard JR. Evidence for the domains supporting the construct of intrinsic capacity. \u003cem\u003eJ Gerontol A Biol Sci Med Sci\u003c/em\u003e 2018; doi:10.1093/gerona/gly011\u003c/li\u003e\n\u003cli\u003eBeard JR, Jotheeswaran AT, Cesari M, Araujo de Carvalho I. The structure and predictive value of intrinsic capacity in a longitudinal study of ageing. \u003cem\u003eBMJ Open\u003c/em\u003e 2019; doi:10.1136/bmjopen-2018-026119\u003c/li\u003e\n\u003cli\u003eBeard JR, Si Y, Liu Z, Chenoweth L, Hanewald K. Intrinsic capacity: Validation of a new WHO concept for healthy aging in a longitudinal Chinese study. \u003cem\u003eJ Gerontol A Biol Sci Med Sci\u003c/em\u003e 2022; doi:10.1093/gerona/glab226\u003c/li\u003e\n\u003cli\u003eLiu S, Yu X, Wang X, Li J, Jiang S, Kang L, Liu X. Intrinsic capacity predicts adverse outcomes using Integrated Care for Older People screening tool in a senior community in Beijing. \u003cem\u003eArch Gerontol Geriatr\u003c/em\u003e 2021; doi:10.1016/j.archger.2021.104358\u003c/li\u003e\n\u003cli\u003eZeng X, Shen S, Xu L, Wang Y, Yang Y, Chen L, Guan H, Zhang J, Chen X. The impact of intrinsic capacity on adverse outcomes in older hospitalised patients: a one-year follow-up study. \u003cem\u003eGerontology\u003c/em\u003e 2021; doi:10.1159/000512794\u003c/li\u003e\n\u003cli\u003eGonzalez-Bautista E, Andrieu S, Guti\u0026eacute;rrez-Robledo LM, Garc\u0026iacute;a-Chanes RE, de Souto Barreto P. In the quest of a standard index of intrinsic capacity: a critical literature review. \u003cem\u003eJ Nutr Health Aging\u003c/em\u003e 2020; doi:10.1007/s12603-020-1394-4\u003c/li\u003e\n\u003cli\u003eMa L, Chhetri JK, Zhang Y, Liu P, Chen Y, Li Y, Chan P. Integrated Care for Older People screening tool for measuring intrinsic capacity: preliminary findings from ICOPE pilot in China. \u003cem\u003eFront Med (Lausanne)\u003c/em\u003e 2020; doi:10.3389/fmed.2020.576079\u003c/li\u003e\n\u003cli\u003eGonz\u0026aacute;lez-Bautista E, de Souto Barreto P, Virecoulon Giudici K, Andrieu S, Rolland Y, Vellas B. Frequency of conditions associated with declines in intrinsic capacity according to a screening tool in the context of Integrated Care for Older People. \u003cem\u003eJ Frailty Aging\u003c/em\u003e 2021; doi:10.14283/jfa.2020.42\u003c/li\u003e\n\u003cli\u003eWon CW, Ha E, Jeong E, Kim M, Park J, Baek JE, Kim S, Kim SB, Roh J, Choi JH, Jeon SY, Jung H, Lee D, Seo Y, Shin H, Kim H. World Health Organization Integrated Care for Older People (ICOPE) and the Integrated Care of Older Patients with Frailty in Primary Care (ICOOP_Frail) Study in Korea. \u003cem\u003eAnn Geriatr Med Res\u003c/em\u003e. 2020 Sep;24(3):125\u0026ndash;131. doi:10.4235/agmr.20.0033. PMID: 33052575; PMCID: PMC7556563.\u003c/li\u003e\n\u003cli\u003eXu Z, Zhao D, Zeng L, et al. Validation of the WHO ICOPE screening tool in Chinese older adults: a pilot study. \u003cem\u003eBMC Geriatr\u003c/em\u003e. 2022;22(1):373. doi:10.1186/s12877-022-03050-w\u003c/li\u003e\n\u003cli\u003eTavassoli N, de Souto Barreto P, Berbon C, Mathieu C, de Kerimel J, Lafont C, Takeda C, Carrie I, Piau A, Jouffrey T, Andrieu S, Nourhashemi F, Beard JR, Soto Martin ME, Vellas B. Implementation of the WHO integrated care for older people (ICOPE) programme in clinical practice: a prospective study. \u003cem\u003eLancet Healthy Longev\u003c/em\u003e 2022; doi:10.1016/S2666-7568(22)00097-6\u003c/li\u003e\n\u003cli\u003eP\u0026eacute;r\u0026egrave;s K, Harsco\u0026euml;t E, Gzil F, et al. Implementation of WHO\u0026rsquo;s ICOPE tool in a population-based cohort: results from the MAPT study. \u003cem\u003eJ Nutr Health Aging\u003c/em\u003e. 2022;26(3):262\u0026ndash;268. doi:10.1007/s12603-022-1743-8\u003c/li\u003e\n\u003cli\u003eLu F, Li J, Liu X, et al. Diagnostic performance analysis of the Integrated Care for Older People (ICOPE) screening tool for identifying decline in intrinsic capacity. \u003cem\u003eBMC Geriatr.\u003c/em\u003e 2023;23:509. https://doi.org/10.1186/s12877-023-04180-x\u003c/li\u003e\n\u003cli\u003eRojano i Luque X, Blancafort-Alias S, Prat Casanovas S, et al. Identification of decreased intrinsic capacity: Performance of diagnostic measures of the ICOPE Screening tool in community dwelling older people in the VIMCI study. \u003cem\u003eBMC Geriatr.\u003c/em\u003e 2023;23:106. https://doi.org/10.1186/s12877-023-03799-0\u003c/li\u003e\n\u003cli\u003eLeung AY, Su JJ, Lee ESH, et al. Intrinsic capacity of older people in the community using WHO Integrated Care for Older People (ICOPE) framework: a cross-sectional study. \u003cem\u003eBMC Geriatr.\u003c/em\u003e 2022;22:304. https://doi.org/10.1186/s12877-022-02980-1\u003c/li\u003e\n\u003cli\u003eLin T, Guo W, Li Y, et al. Geographical accessibility of medical resources, health status, and demand of integrated care for older people: a cross-sectional survey from Western China. \u003cem\u003eBMC Geriatr.\u003c/em\u003e 2024;24:440. https://doi.org/10.1186/s12877-024-04987-2\u003c/li\u003e\n\u003cli\u003eSu HC, Liu C, Chen HY, et al. Assessing intrinsic capacity in Taiwan: Initial psychometric properties of the Integrated Care for Older People Screening Tool for Taiwanese (ICOPES-TW). \u003cem\u003eBMC Geriatr.\u003c/em\u003e 2024;24:477. https://doi.org/10.1186/s12877-024-05071-5\u003c/li\u003e\n\u003cli\u003eChhetri JK, Ma L, Zhang Y, et al. Integrated care for older adults in India and China: A realist evaluation. \u003cem\u003eAging Med (Milton)\u003c/em\u003e. 2021;4(2):124\u0026ndash;131. https://doi.org/10.1002/agm2.12161\u003c/li\u003e\n\u003cli\u003eGobbens RJJ, van Assen MALM. Global application of the ICOPE framework: A scoping review. \u003cem\u003eBMC Geriatr.\u003c/em\u003e 2022;22:812. https://doi.org/10.1186/s12877-022-03450-y\u003c/li\u003e\n\u003cli\u003eGonz\u0026aacute;lez-Bautista E, Barreto PD, Virecoulon Giudici K, et al. Intrinsic capacity predicts negative health outcomes in older adults: A 2-year longitudinal study. \u003cem\u003eJ Gerontol A Biol Sci Med Sci.\u003c/em\u003e 2021;76(5):905\u0026ndash;912. https://doi.org/10.1093/gerona/glaa295\u003c/li\u003e\n\u003cli\u003eZulfiqar T, Hajjam M, Tavassoli N, et al. Nurse-led integrated care for older people in rural France: an evaluation of ICOPE implementation. \u003cem\u003eBMC Nurs.\u003c/em\u003e 2023;22:18. https://doi.org/10.1186/s12912-023-00944-2\u003c/li\u003e\n\u003cli\u003ede Kerimel J, Tavassoli N, Lafont C, et al. Implementation of WHO ICOPE digital tools in primary care: Lessons from INSPIRE-T. \u003cem\u003eJ Frailty Aging.\u003c/em\u003e 2022;11(5):520\u0026ndash;525. https://doi.org/10.14283/jfa.2022.33\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Intrinsic capacity, WHO ICOPE, Healthy ageing, integrated care, older adults","lastPublishedDoi":"10.21203/rs.3.rs-7241838/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7241838/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe World Health Organization (WHO) introduced the Integrated Care for Older People (ICOPE) approach to assess Intrinsic Capacity (IC) across six domains: cognition, psychological capacity, vitality, mobility, vision, and hearing. This study evaluated the impact of an ICOPE-based personalized care plan over six months on IC and quality of life, measured using the WHO-5 Wellbeing Index.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA prospective cohort study was conducted among 135 individuals aged ≥60 years in a tertiary care setting. At baseline, IC was assessed using the ICOPE framework, and personalized care plans were developed to address IC deficits. Participants were reassessed after six months. Primary and secondary outcomes included changes in WHO-5 Wellbeing Index scores and the number of impaired IC domains, respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf the 135 participants (mean age: 69 ± 5 years, 57% males), 107 (78%) completed follow-up. At baseline, 89% had at least one impaired IC domain, with vision (63%) and psychological capacity (44%) being the most affected. Over six months, the mean number of impaired IC domains decreased from 2.11 ± 0.94 to 1.33 ± 1.13 (p \u0026lt; 0.001), and WHO-5 Wellbeing Index scores improved significantly from 14.65 ± 4.38 to 17.98 ± 3.54 (p \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eICOPE-based personalized care plans significantly improved IC and wellbeing among older adults. These findings highlight the potential of ICOPE interventions in geriatric care, warranting further validation through randomized controlled trials.\u003c/p\u003e","manuscriptTitle":"Effect of an ICOPE-Based Personalized Care Plan on Intrinsic Capacity and Wellbeing Among Older Adults: A Prospective Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-10 18:57:43","doi":"10.21203/rs.3.rs-7241838/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"111142053294852206277958592923716173644","date":"2025-09-08T07:07:32+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-03T17:24:25+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-11T06:34:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-08T10:31:45+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-08T10:29:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2025-07-29T09:41:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ea187d20-48f9-4c57-b542-41354dcadf7a","owner":[],"postedDate":"September 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-09-10T18:57:43+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-10 18:57:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7241838","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7241838","identity":"rs-7241838","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}