Year: 2025
Type: article
Abstract: Editorial to accompany: Implementation and impact of the World Health Organization Integrated Care for Older People (ICOPE) program in China: a randomised controlled trial [4] ICOPE randomised controlled trials are showing efficacy. Trials must be extended to a longer time period to measure health and economic outcomes. ICOPE study is an important advance in the field of healthy longevity. In most western countries, geriatric medicine was funded several decades ago not because the ageing of our society was anticipated, but because many older people with comorbidities, severe dependency and dementia were and still are being referred to hospital emergency departments, and nobody was able to take care of them. Since then, long-term care inpatient units, subacute care, acute care and nursing homes have been created to receive such patients. Of course, it is the honour of geriatric medicine to take care of severely dependent patients. However, at this stage, it is far too late to reverse this dependency and we need to act at an earlier stage. Since we have been targeting frail older adults (as an example, we created a frailty clinic at the Toulouse Gerontopole 15 years ago), it is still difficult for these subjects, who are usually aged more than 80 years old, to successfully intervene in several disabilities at the same time. This is why the WHO, with John Beard and Islene Araujo de Carvalho, created the Integrated Care of Older People (ICOPE) programme. [1] For the WHO, healthy ageing means maintaining our function in order to be able to continue to do what we value the most. To be able to do this, we must shift geriatric medicine to healthy ageing. To do this, we need to ask what patients want to continue to do and how we can help them as much as possible. The WHO has identified the six most important functions to maintain: vision, hearing, mobility, nutrition, psychological health and memory. The ICOPE programme includes five steps: step 1 screening, step 2 deeper assessment, step 3 intervention, step 4 monitoring and step 5 having a favourable environment for healthy longevity. As a WHO Collaborative centre, in Toulouse, we have implemented ICOPE in clinical practice and now follow more than 66 000 older adults with ICOPE Monitor digital app, we have been able a propose some percentiles references and have also confirmed Icope predictive values [2, 3]. The study by Ninie Yan Wang from China [4] is one of the first randomised clinical trials (RCTs) in community-dwelling older adults at-risk of functional declines. The primary objective was feasibility. It is a 6-month intervention programme following WHO’s ICOPE care pathways implemented by integrated care managers compared to standard available care. Participants in the intervention and control groups (938) had comparable baseline characteristics, and the trial demonstrated the feasibility of implementing ICOPE with high satisfaction by participants (97–99%) and providers (92–93%). Such very high satisfaction rates are in line with our clinical experience. In terms of outcomes, after the 6-month intervention, there were improvements in vitality (Mini-Nutritional Assessment Short Form), mobility (Short Physical Performance Battery) and psychological health (Geriatric Depression Scale). This study is an important advance in the field of healthy longevity; however, we now need long-term RCTs to see if we can bring about sustained gains. In France, we are presently conducting the ICOPE RCT on 1000 subjects aged over 70 years. We are testing a 3-year intervention versus a control group, with 2 years additional follow-up, and have three objectives: to maintain function, measure health economic outcomes and study the effects on the biology of ageing. The future of geriatric medicine is moving towards healthy longevity, with learning from advances in geroscience, [5] in order to be able to maintain function and postpone or better cure age-related diseases. The IHU HealthAge received funding from the French National Research Agency (ANR) as part of the France 2030 program (reference number: ANR-23-IAHU-0011). None declared. None declared.
Source: Age and Ageing
Author: Vellas Bruno
Institutions: Inserm, Centre Hospitalier Universitaire de Toulouse
Language: English
Topic: Frailty in Older Adults
Subfield: Geriatrics and Gerontology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Funder: Agence Nationale de la Recherche
OpenAlex ID: W4413257997