Identification of decreased intrinsic capacity: Diagnostic performance indicators of the ICOPE Screening tool in community-dwelling older people in the VIMCI study

Abstract

Abstract Background: The WHO has developed the Integrated Care for Older People (ICOPE) strategy to face the challenges of ageing societies. This strategy is focused on person centered care and the assessment intrinsic capacity (IC). Early identification of five domains of IC (cognition, locomotion, vitality, sensory (hearing and vision), and psychological) has been shown to be related with adverse outcomes and can guide actions towards primary prevention and healthy aging. IC assessment proposed by the WHO ICOPE guidelines is composed by two steps: First, Screening for IC declines in IC by the ICOPE Screening tool; second, by the reference standard methods. The aim was to assess the diagnostic performance indicators (sensibility, specificity, diagnostic accuracy, and agreement of the ICOPE Screening tool) compared to the reference standard methods in European community-dwelling older adults. Methods: Cross-sectional analysis of the baseline of the ongoing VIMCI cohort study, which was carried out in Primary Care centers and outpatient clinics from 5 rural and urban territories in Catalonia (Spain). Participants were 207community dwelling persons ≥ 70-year-old with Barthel ≥ 90, without dementia or advanced chronic conditions who provided their consent to participate. The 5 IC domains were assessed by the ICOPE Screening tool and the reference methods (SPPB, gait speed, MNA, Snellen chart, audiometry, MMSE, GDS5) during patients’ visit. Agreement was assessed with Gwet AC1 index. Results: ICOPE Screening tool sensitivity was higher for cognition (0.889) and ranged between 0.438 and 0.569 for most domains. Specificity ranged from 0.682 to 0.96, diagnostic accuracy from 0.627 to 0.879, Youden index from 0.12 to 0.619, and Gwet AC1 from 0.275 to 0.842 Conclusion: The ICOPE screening tool showed fair diagnostic performance indicators; it was helpful to identify those participants with satisfactory IC and showed a modest ability to identify IC decline in older people with high degree of autonomy. This limitation may be overcome by repeating periodically the screening in those with satisfactory screening for IC. The screening for IC could be considered for implementation into clinical practice.