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Project ICOPE Brazil: a study on the intrinsic capacity of Brazilian
older adults and accuracy of the screening tool proposed by the World Health
Organization
Projeto ICOPE Brasil: um estudo sobre capacidade intrínseca de idosos
brasileiros e da acurácia do instrumento de rastreamento proposto pela
Organização Mundial da Saúde
Eduardo Ferriolli eduardo.ferriolli@fm.usp.br
Universidade de São Paulo, Brazil
Universidade de Sao Paulo, Brazil
Universidade de São Paulo, Brazil
Universidade de São Paulo, Brazil
Roberto Alves Lourenço
Universidade de São Paulo, Brazil
Universidade do Estado do Rio de
Janeiro, Brazil
Vitor Pelegrim de Oliveira
Universidade de São Paulo, Brazil
Hospital de Clínicas de Porto
Alegre, Brazil
Universidade Federal do Rio Grande do
Sul, Brazil
Renato Gorga Bandeira de Mello
Universidade de São Paulo, Brazil
Hospital de Clínicas de Porto
Alegre, Brazil
Universidade Federal do Rio Grande do
Sul, Brazil
Renata Eloah de Lucena Ferretti-Rebustini
Universidade de São Paulo, Brazil
Universidade de São Paulo, Brazil
Universidade de São Paulo, Brazil
Wilson Jacob
Universidade de São Paulo, Brazil
Universidade de São Paulo, Brazil
Universidade de São Paulo, Brazil
On behalf of the members of Núcleo de Pesquisa sobre o Envelhecimento e
o Idoso (NAPENV)
Geriatrics, Gerontology and Aging, vol. 17, e0230003, 2023
Sociedade Brasileira de Geriatria e Gerontologia,
SBGG
Received: 21 January 2023
Accepted: 31 January 2023
Funding
Funding source: CNPq
Contract number: 406612/2021-8
Funding statement: This project received funding from the Brazilian National
Research Council (CNPq) (grant number 406612/2021-8).
In its 2015 World Report on Ageing and Health,1 the World Health Organization (WHO) defined healthy aging as the
process of developing and maintaining functional ability to enable well-being in older
age.
In 2017, WHO published guidelines for the implementation of a public health strategy with
this purpose: Integrated Care for Older People (ICOPE).2 Based on the concepts of
functional ability (the health-related attributes that enable
people to be and to do what they have reason to value), intrinsic
capacity (IC, the combination of all physical and mental capacities that an
individual has at their disposal), and patient-centered care, the ICOPE
strategy systematically established a set of actions at the primary care level to screen
and identify people at greater risk of adverse health outcomes, as well as suggested
affordable interventions that can improve their overall health.2 Optimization of IC can have a significant impact on quality of
life, reducing care dependency and, consequently, relieving the burden on health
services.2
Once the concept of IC was consolidated, WHO began to discuss the feasibility of
establishing – based on suggestions from a group of experts – the standards, clinical
regulations, and roadmaps needed to implement its Global Strategy and Plan of Action for
Aging And Health.3 This multidisciplinary panel of
experts from several WHO international centers, known as the WHO Clinical Consortium on
Healthy Aging (CCHA), established strategies to revolutionize clinical practice and
define a toolkit to screen for IC loss and for implementing the ICOPE strategy in each
country.4 The main objective of this
initiative is to provide evidence-based recommendations to identify, monitor, and manage
IC in integrated health care networks, considering the six domains of IC (locomotor
capacity, vitality, visual capacity, hearing capacity, cognitive capacity, and
psychological capacity).2
The expert panel reviewed publications that evaluated instrument metrics and conducted a
series of systematic reviews designed to determine the validity and reliability of
diagnostic instruments, as well as to assess the psychometric properties of previously
validated screening tests.4
The gateway to the system proposed by WHO thus constituted of the administration of a
screening tool covering the six aforementioned domains (locomotor capacity, vitality,
visual capacity, hearing capacity, cognitive capacity, and psychological capacity),
composed of a series of questions and rapid tests.4 Although constructed by highly regarded specialists and based on
systematic reviews, as a whole, the tool was not robustly evaluated in terms of evidence
of its validity and reliability – a fundamental step of the scientific method for any
new evaluation instrument.
The currently available evidence on implementation of the WHO ICOPE strategy is still
scarce and based on a heterogeneous literature, especially with regard to scientific
quality. Some findings are derived from models built with retrospective data;5,6 others
were obtained from prospective studies that actually used the ICOPE screening tool as
designed. Nevertheless, even direct evidence has methodological limitations that can
compromise the quality of the information derived therefrom, mainly due to selection
biases in the included samples and by the limited (or absent) applicability of
psychometric methodologies to test the validity of clinical assessment instruments.7,8,9 Therefore, although ICOPE is based on sound
concepts, data on its applicability in a real-life setting – especially from
longitudinal studies – remains scarce. Further research following rigorous protocols is
needed to bridge these knowledge gaps.
In Brazil, a group of specialists in the fields of human aging and epidemiology has been
working on a project designed to evaluate the IC of older Brazilians who receive care at
primary health units. Toward this end, the Núcleo de Pesquisa sobre o Envelhecimento e o
Idoso (NAPENV, Universidade de São Paulo) took on the task of bringing together
researchers from 16 universities in Brazil (Universidade de São Paulo, Universidade
Estadual de Campinas, Universidade Federal do Mato Grosso, Universidade Federal do Rio
Grande do Sul, Universidade Federal do Amazonas, Universidade Federal do Rio Grande do
Norte, Universidade do Estado do Rio de Janeiro, Universidade Federal de Minas Gerais,
Universidade Federal do Ceará, Universidade Federal dos Vales do Jequitinhonha e Mucuri,
Universidade Federal de Alfenas, Universidade Federal de Juiz de Fora, Universidade
Federal de Santa Catarina, Universidade Federal do Triângulo Mineiro, Universidade
Federal de Pernambuco, Universidade Federal do Sergipe) and abroad (Université de
Toulouse, France; University of Birmingham, England), from several fields of knowledge
(physical education, nursing, epidemiology, physiotherapy, medicine, occupational
therapy), to co-design a rigorous investigative procedure on IC, the ICOPE strategy, and
the validity of its screening tool. This union of researchers at NAPENV, in turn, led to
the proposal of a multicenter, nationwide, prospective cohort study titled “Projeto
ICOPE Brasil: avaliação da capacidade intrínseca nos idosos como fundamento para a
implantação do ICOPE (Integrated Care for Older People) da Organização
Mundial da Saúde no Sistema Único de Saúde” [Project ICOPE Brazil: assessment of
intrinsic capacity in older adults as a basis for implementation of the WHO ICOPE
strategy in the Unified Health System]. Project protocol design is in its final stages,
and development is expected to begin in early 2023.
With this initiative, we hope to add to the knowledge of intrinsic capacity in Brazilian
older adults who receive care in primary health units and to provide evidence of the
validity and reliability of the ICOPE screening tool for measuring IC when applied in a
primary health care (PHC) setting. Furthermore, and in an unprecedented manner, the
longitudinal design of the ICOPE Brazil study will allow us to conduct a robust
assessment of the capacity of various social, physical, and mental factors to predict IC
decline, as well as to understand the role of IC loss in predicting major geriatric
outcomes (such as functional and cognitive decline, falls, hospitalizations, and
mortality) during follow-up.
Considering all the issues that still apply to development of the ICOPE strategy and the
assessment of intrinsic capacity, Project ICOPE Brazil will contribute not only to the
development of a solid scientific foundation for the care of older adults in Brazil, but
also to the development of this important WHO initiative at the global level.
