Integrated Care For Older People (ICOPE) Implementation Pilot Programme

INTEGRATED CARE FOR OLDER PEOPLE
Integrated care for older people (ICOPE)

implementation pilot programme:
findings from the

‘ready’ phase
INTEGRATED CARE FOR OLDER PEOPLE
Integrated care for older people (ICOPE)

implementation pilot programme:
findings from the

‘ready’ phase
Integrated care for older people (ICOPE) implementation pilot programme: findings from the ‘ready’ phase
ISBN 978-92-4-004835-5 (electronic version)

ISBN 978-92-4-004836-2 (print version)
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Design and layout by Erica Lefstad

iii
CO N T E N T S
Acknowledgements v
EXECUTIVE SUMMARY vi
BACKGROUND 3
The ICOPE approach and its implementation 5
DESIGN OF THE THREE-STEP ICOPE

IMPLEMENTATION PILOT PROGRAMME 9
Ready-phase methods to assess ICOPE implementation readiness 10
FINDINGS FROM THE READY PHASE 15
Survey results on readiness at level of service delivery and clinical care 15

Country case studies on readiness at level of service delivery and clinical care 20
Survey results on readiness at the services and systems level 36
Readiness by country income levels and regions 38
Readiness by specific actions in support of ICOPE 40
LEARNING GAINED IN THE ICOPE PILOT READY PHASE 43
Informing the next phases of ICOPE implementation 45
REFERENCES 46
ANNEXES 48
Annex 1: Micro survey on ICOPE implementation in clinical and community setting 48

Annex 2: Respondents to micro survey 60
Annex 3: Respondents to service- and system-level survey using scorecard 62
Annex 4: Capacities, enablers and barriers for ICOPE adoption in clinical settings,
by income levels and regions 64
Annex 5: Attitudes towards implementation of ICOPE and changes to clinical practice 82
Annex 6: Implementation readiness by WHO region 84
Annex 7: Implementation readiness by specific actions 86
ICOPE implementation pilot programme: findings from the ‘ready’ phase iv
Acknowledgements v
AC K N OW L E D G E M E N T S
This ready phase ICOPE pilot programme report was produced (Kyung-Hee University, Republic of Korea); Olga Manukhina
under the overall technical oversight of Yuka Sumi, Medical (WHO Russia office, Russian Federation); Sergi Blancafort Alias
Officer, Ageing and Health Unit (AAH), with the direction of (Health and Ageing Foundation, Autonomous University of
Anshu Banerjee, Director, Maternal, Newborn, Child and Barcelona, Spain); Leon Geffen (Samson Institute for Ageing
Adolescent Health and Ageing Department, within the Division Research, South Africa); Adrian Hayter (NHS England and NHS
of Universal Health Coverage, Life Course at the World Health Improvement, United Kingdom of Great Britain and Northern
Organization (WHO) headquarters in Geneva. The pilot Ireland); Ian Philp (Age Care Technologies, United Kingdom);
programme ready phase was designed and developed by Thi Kim Phuong Nguyen, Linh Diew Pham (WHO Viet Nam
Yuka Sumi, Michael Valenzuela (consultant, AAH), Eric Ohuma office, Viet Nam).
(consultant, AAH). The principal report writers were Rachel
Albone (consultant, AAH), Michael Valenzuela and Andrew For their careful review of the report, WHO would like to thank
Briggs (consultant, AAH) with the supervision of Yuka Sumi. Luis Bautzer (Olyst Integrated Care Management, France),
AB Dey (Venu Charitable Society Sheikh Sarai, India), Pauline
The steering group for the development of the ready phase of Kleinitz (WHO headquarters), Angela Leung (Hong Kong
the ICOPE pilot programme report consisted of the following Polytechnic University, China), Kafi Lubis (WHO Indonesia office,
WHO regional advisers: Francoise Bigirimana, Innocent Indonesia), Leocadio Rodríguez Mañas (Hospital Universitario
Bright Nuwagira, Saliyou Sanni, Fatim Tall (Regional Office de Getafe, Spain), Finbarr Martin (King’s College London,
for Africa); Patricia Morsch, Enrique Vega (Regional Office for United Kingdom), Chris Mikton (WHO headquarters), Jean Yves
the Americas); Samar Elfesky (Regional Office for the Eastern Reginster (WHO Collaborating Center for Public Health Aspects
Mediterranean); Manfred Huber, Stefania Ilinca, Satish Mishra of Musculoskeletal Health and Aging, University of Liege,
(Regional Office for Europe); Neena Raina (Regional Office Belgium), Saniya Sabzwari (Aga Khan University, Pakistan) and
for South-East Asia); Hiromasa Okayasu (Regional Office for Jean Woo (Chinese University of Hong Kong, China).
the Western Pacific); and colleagues from WHO technical
departments at the headquarters (Shelly Chadha, Alarcos Cieza, Appreciation for their insightful comments goes to AAH team
Tarun Dua, Silvio Paolo Mariotti, Maria Nieves Garcia-casal). members: Hyobum Jang, Jothees Amuthavalli Thiyagarajan,
Matteo Cesari (consultant, AAH) and Ritu Sadana with support
The principal investigators contributing country case studies to analyse the survey data from Ming Ong (consultant, AAH).
were Eva Heras Muxella (Servei Andorrà d’Atenció Sanitària,
Andorra); Amy Song, Ninie Wang (Pinetree Care Group, China); We also benefitted from the inputs of participants at the
Philipe de Souto Barreto, Neda Tavassoli, Bruno Vellas annual meetings of the WHO Clinical Consortium on Healthy
(WHO Collaborating Centre for Frailty, Clinical Research and Ageing, 2020 and 2021.
Geriatric Training, Toulouse University Hospital, France); Arvind
Mathur (Asian Centre for Medical Education, Research and None of the experts involved in the development of this
Innovation, India). document declared any conflict of interest.
For support on facilitating surveys, we thank Edith Pereira The WHO AAH unit acknowledges the financial support of
(WHO Cabo Verde office, Cabo Verde); Mario Cruz Penate the Government of Germany, the Kanagawa prefectural
(WHO Chile office, Chile); Tuohong Zhang (WHO China government in Japan and the Universal Health Coverage
Office, China); Eliane Vanhecke (Ministry of Health, France); Partnership (Belgium, Canada, European Union, Germany,
Itsnaeni Abbas, Tara Mona Kessaram (WHO Indonesian office, Luxembourg, Ireland, France, Japan, United Kingdom
Indonesia); Marco Canevelli, Nicola Vanacore (National Institute and WHO).
of Health, Italy); Muthoni Gichu (Ministry of Health, Kenya);
Sandra Pais (University of Algarve, Portugal); Chang Won
ICOPE implementation pilot programme: findings from the ‘ready’ phase vi
E X E C U T I V E S U M M A RY
Integrated care for older people (ICOPE) reflects a This report summarizes the findings of the ready phase
continuum of care that helps to reorient health and social from the implementation experiences across nominated
services towards a more person-centred and coordinated Member States, including enablers, barriers and strengths
model of care that helps optimise older people’s intrinsic for the implementation of the ICOPE approach, and learning
capacity (physical and mental capacities) and functional on the preparation and adaptation needed to implement
ability. Successful implementation of WHO’s ICOPE ICOPE. The findings will inform the further scale up of the
approach requires coordination between multiple approach.
parts of the health and social care systems, through a
multidisciplinary team that includes older people and their The majority of respondents of the micro survey expressed
families, health and care workers, communities and civil positive attitudes towards the ICOPE approach, agreeing
society organizations. that integrated care is important to promoting the
maintenance of, and preventing declines in, intrinsic
In order to support Member States to implement ICOPE, capacity and functional ability. Most also stated the need to
WHO is conducting a three-phase research project, the change current practice to the provision of person-centred
‘ICOPE implementation pilot programme’, comprising ready, integrated care. Health and care workers consistently
set and go phases. The objective of the ready phase is to identified the proactive engagement of older people as a
evaluate readiness and feasibility to implement ICOPE at key enabler across all steps of the ICOPE care pathway.
the service and systems levels. Three sub-studies have
been undertaken, two addressing the clinical (micro) and Respondents identified that integrated care was more
service (meso) levels, and a third focused on service and time-consuming, complex and challenging than the current
system (macro) levels. At the clinical and service levels, the practice and highlighted human resource capacity as a
studies focused primarily on the views and experiences of barrier. The need to increase local workforces and for training
health and care workers through an online micro survey, was identified, particularly for screening and assessment
and four country case studies (Canillo in Andorra, Chaoyang of declines in intrinsic capacity. In lower-middle-income
in Beijing, China, Occitanie in France and Rajasthan in
India). At the service and system levels, the study utilised
the ICOPE implementation framework through an online
implementation scorecard survey to assess capacity to
deliver integrated care.
The studies suggested a good

level of buy-in and enthusiasm
for ICOPE, with positive feedback
received from older participants.
Executive summary vii
countries, additional training was also highlighted as important Aligned with the micro level survey, human resource
for the assessment and management of the environment as constraints were a common barrier highlighted by all four
well as the development of personalized care plans. A lack of studies, both in terms of the number of health and care
infrastructure and of systems integration were found to be workers, and the time they were able to give to implement
potential barriers to the development of personalized care the ICOPE approach. Financial barriers to implementation,
plans. Respondents from lower-middle-income countries also including health insurance coverage and staff time, were
identified a lack of digital integration of health information as also highlighted.
a barrier and welcomed the mobile ICOPE handbook app and
data dashboard as enabling tools. The studies demonstrated the role ICOPE can play in
encouraging coordination and collaboration among health
The four country case studies focused primarily on piloting and care workers and among different stakeholders in the
ICOPE within existing clinical and community (micro) health and social care systems, including local and national
settings and services (meso). They have shown the usability government.
and feasibility of ICOPE and highlighted the preparation
and adaptation necessary to implement the approach in
different contexts The studies demonstrated
Although the scale of studies varied, all older participants were
the role ICOPE can play in
assessed through an ICOPE screening. Identifying potential encouraging coordination and
declines in intrinsic capacity through screening enables
opportunities to provide the interventions to prevent and slow collaboration among health
decline and prevent care dependency. The studies suggested
a good level of buy-in and enthusiasm for ICOPE, with
and care workers
positive feedback received from older participants. The four
research teams also stressed the importance of older people’s
participation as a crucial enabler for ICOPE implementation
and its role in promoting empowerment and increasing
knowledge on health and well-being.
ICOPE implementation pilot programme: findings from the ‘ready’ phase viii
KEY OPPORTUNITIES FOR ICOPE

IMPLEMENTATION:
1 Positive attitudes from health and care workers towards

the principles of integrated care and high levels of
commitment to adopt and implement ICOPE. With
appropriate workforce capacity-building and creating
enabling service delivery environments, care and service
delivery can change;
2 Proactive engagement of older people and their

communities is crucial across all steps of the ICOPE care
pathway. This was highlighted in feedback from both
older participants, and health and care workers;
3 ICOPE is feasible to implement in different contexts, as

shown by case studies from different countries, which
also demonstrated the value of local co-design and
adaptation to suit local context.
Executive summary ix
The service- and system-level (implementation scorecard) The United Nations Decade of Healthy Ageing (2021–2030)
survey showed a large range of scores across countries, is an important opportunity for stakeholders to come
suggesting that implementation readiness is context- together to deliver its vision for “a world in which all people
specific. Irrespective of economic development, can live longer and healthier lives”. The implementation of
implementation readiness was higher on average for ICOPE will play an important role in this effort. By focusing
services than for systems. The greatest implementation on the promotion of intrinsic capacity and the prevention
readiness was associated with the service action to “actively of declines through the provision of integrated, person-
engage older people, their families and caregivers and centred care, ICOPE will facilitate ‘Healthy Ageing’.
civil society”, while the least was with “deliver care that is
acceptable to older people, effective and targets functional The findings in this report can support governments
ability”. At the systems level, readiness was most commonly to recognize the value of responding to the additional
associated with the action to “develop capacity in the resource needs of implementing ICOPE as part of efforts
current and emerging workforce to deliver integrated care”, towards universal health coverage. With the successful
while “digital technologies to support older people’s self- implementation of ICOPE, supported by high levels of
management” were rarely in place. grassroots support and stakeholder engagement, we can
expect a brighter future for older people around the world.
The findings in this report can

support governments to recognize the
value of responding to the additional
resource needs of implementing ICOPE
as part of efforts towards universal
health coverage
Public health students provide health
and lifestyle advice following ICOPE
screening. Pilot site in Jodhpur District,
Rajasthan, India.
Photocredit: School of Public Health, All India Institute
of Medical Sciences, India.
ICOPE implementation pilot programme: findings from the ‘ready’ phase 2
The United Nations Decade of Healthy Ageing is

focused on four action areas: changing how we
think, feel and act towards age and ageing; ensuring
that communities foster the abilities of older people;
delivering person-centred, integrated care and
primary health services responsive to older people;
and providing access to long-term care for older
people who need it.
3
B AC KG R O U N D
Over the last 50 years, countries around the world have experienced
a rapid decline in fertility rates alongside significant increases in life
expectancy, leading to the global demographic trend of population
ageing. While increasing life expectancy is an important goal, improving
healthy life expectancy is crucial to ensuring that, as populations age,
individuals are not living their later lives in poorer health and with
significant loss of intrinsic capacity and functional ability.
intrinsic capacity: the composite of all the
physical and mental capacities of the individual
Although there is no single common experience of ageing, physiological
changes do occur with increasing age. As we age, we are at risk of functional ability: the combination of the
experiencing a decline in our intrinsic capacity and, without support, also intrinsic capacity of the individual, the environment
a person lives in, and how people interact with their
deteriorations in our functional ability. Older people often face increased
environment
risks for chronic diseases and care dependency (1).
To address these challenges, efforts are needed to

support healthy ageing.
healthy ageing: the process of developing
and maintaining the functional ability that
In response to rapid population ageing, the World Health enables well-being in older age (2)
Organization (WHO) developed the World report on ageing and health
in 2015 (2), followed by the Global strategy and action plan on ageing
and health in 2016 (3). A proposal for a Decade of Healthy Ageing
was endorsed by the World Health Assembly in 2020 and adopted by
the United Nations General Assembly in December 2020 (4), leading
to the proclamation of a United Nations Decade of Healthy Ageing
(2021–2030). The Decade is focused on four action areas (5): changing
how we think, feel and act towards age and ageing; ensuring that
communities foster the abilities of older people; delivering person-
centred, integrated care and primary health services responsive to
older people; and providing access to long-term care for older people
who need it.
ICOPE
ICOPE
implementation
implementation
pilot
pilot
programme:
programme:
findings
findings
from
from
thethe
‘ready’
‘ready’
phase
phase 4
FIGURE 1.
The six conditions associated with declines
in intrinsic capacity
Limited mobility
Depressive symptoms
Cognitive decline
Hearing loss
Visual impairment
Malnutrition
Background 5
Many older people lack knowledge about their health

THE ICOPE APPROACH AND
and may consider declines to be a ‘natural part of ageing’.
ITS IMPLEMENTATION Health-seeking behaviour often declines when older people
do not believe interventions or support are available.
WHO developed the integrated care for older people (ICOPE) Furthermore, early markers of decline in intrinsic capacity,
approach in recognition of the need for a transformation such as decreased gait speed or reduced muscle strength,
of health and social care systems to deliver integrated and are often not identified by health and care workers due to
person-centred care for older people (6). Through a process a lack of training in older people’s health. This can result in
of consultation with leading experts in the WHO Clinical missed opportunities to reverse or delay declines through
Consortium on Healthy Ageing (CCHA), WHO published appropriate monitoring and care.
the evidence-based ICOPE guidelines to manage declines in
intrinsic capacity in the community in 2017 (7) and a package The ICOPE approach therefore aims to support health and
of supporting tools, including the ICOPE implementation care workers to detect declines in older people’s intrinsic
framework for policy-makers and programme managers (8), capacity in community and primary care settings by
ICOPE handbook for health and care workers (9) and an ICOPE conducting person-centred assessments and developing
handbook mobile app. personalized care plans with older people. The approach
also provides an opportunity to empower and engage
older people in their health and care. The six priority
conditions associated with declines in intrinsic capacity
The app is available from Apple or Google
are given in FIGUR E 1. Assessment and management of
each of these conditions as well as social care needs are
included in the ICOPE approach (FIGUR E 2).
The ICOPE approach provides

an opportunity to empower and
engage older people in their
health and care
Implementing the ICOPE approach in clinical settings

involves a five-step pathway (FIGUR E 2) to address the
The implementation and
health and social care needs of older people. This includes
screening, assessment, the development of personalized
scale-up of the ICOPE
care plans based on individuals’ goals and preferences,
approach requires support
the management of declines in intrinsic capacity and
underlying conditions, and taking into account the from multiple levels of
environments to support functional ability. The pathway
involves tracking progress through management, referral health and social care
and monitoring, and having linkages to community and
carer support. systems and, in some
Successful implementation of ICOPE involves all steps cases, transformational
of the pathway being provided for older people, so that
people at potential risk of declining intrinsic capacity –
change
as demonstrated by the initial screening and a person-
centred assessment – receive the care and support they
Most reform efforts in the context of ICOPE have centred
need through the development of a care plan and follow
on the micro level, with comparatively less attention given
up. The approach requires coordination between multiple
to the meso and macro levels (10). WHO responded to
parts of the health and social care systems, through a
this gap by empirically deriving a framework of actions to
multidisciplinary team that includes health and care workers,
support Member States in the implementation of the ICOPE
family, support groups and civil society organizations.
approach (11).
The implementation and scale-up of the ICOPE approach

The ICOPE implementation framework (FIGURE 3) proposes
requires support from multiple levels of health and
19 actions across five domains: three that comprise nine
social care systems and, in some cases, transformational
actions targeting the service (meso) level and two domains
change. Three levels of realignment are relevant:
comprising 10 actions targeting the system (macro) level.
Along with the listing of these actions for health and
c hanges in clinical practices and attitudes of health social care services and systems, the framework (11) also
and care workers, including to older people’s provides an implementation scorecard, which has been
participation in their care (at the micro level); used in this pilot programme. This prompts policy-makers,
system and programme managers to consider and assess
the implementation readiness, nationally and sub-
c hanges in how health and social care services
nationally, to deliver ICOPE across health and social care
operate and integrate (at the meso level);
systems and services.
s trengthening of health and social care systems

with a focus on governance, financing and strategic
direction (macro level).
Background 7
FIGURE 2.
The ICOPE approach: a five-step person-centred
assessment and care pathway
SCREEN
1 FOR LOSSES IN
INTRINSIC CAPACITY
2
PERSON-CENTRED ASSESMENT IN PRIMARY CARE
Assess in greater depth for conditions associated with loss in intrinsic capacity
Assess and manage underlying diseases
Assess and manage social and physical environments
3
DESIGN A
PERSONALIZED CARE PLAN
Person-centred goal setting
Multidisciplinary team
ENSURE REFERRAL PATHWAY AND
Design a care plan, including multicomponent
MONITORING OF THE CARE PLAN interventions, management of underlying
with links to specialized geriatric care diseases, self-care and self-management
and social care and support
4
Referral and follow up
55 ENGAGE COMMUNITIES
AND SUPPORT CAREGIVERS
FIGURE 3.
The ICOPE implementation framework
Support the coordination MACRO

(System level) Strengthen governance
of services delivered by
and accountability systems
multidisciplinary providers
MESO
(Service level)
Orient services towards

community-based care
MICRO
(Person-centred goal)
Maximize intrinsic
capacity and
functional ability
Enable system-level
strengthening
Engage and empower

people and communities
The objective of this ready phase pilot

is to evaluate the readiness and feasibility
to implement ICOPE, focusing on all three
levels of implementation readiness
9
D E S I G N O F T H E T H R E E - S T E P I CO P E
I M P L E M E N TAT I O N P I LOT P R O G R A M M E
Focusing on these three levels of implementation readiness for

Following the development of the ICOPE approach,
ICOPE, this report is targeted to policy-makers at the system
WHO launched an implementation pilot programme in
level (nationally, regionally and locally), programme managers
collaboration with experts from the CCHA (12), consisting of
at the service level, and health and care workers at the clinical
three phases – ready, set and go. The objective of this ready
level. Its main objective is to highlight the results and learning
phase pilot is to evaluate the readiness and feasibility to
from the ready phase. These have been informed by focused
implement ICOPE, focusing on the following three levels:
interviews on the usability of the ICOPE care pathway in clinical
and community settings and by surveys examining readiness
Clinical (micro) level: determining the acceptability and
in nominated Member States.
feasibility of the approach, by learning how integrated
care is provided in clinical and community setting;
As summarized in FIGURE 4, a further two phases will
ervice (meso) level: assessing the capacity of
S complete the sequence of interlinked projects in this
available services to respond to care needs, identifying three-step programme to comprehensively pilot the ICOPE
challenges and enablers; approach.
S
ystem (macro) level: measuring the capacity of
systems to support ICOPE.
FIGURE 4.
Phases of the ICOPE piloting programme
READY SET GO
2020–2021 2022–2023 2023–2025
Usability check Global field study Randomized validation

Readiness mapping
Prospective study in selected Member Multinational randomized study of the
What is the usability of the ICOPE care States across the income brackets of ICOPE approach (clarified through the ready
pathways in clinical and community setting? low, middle and high, to: and set phases for readiness, feasibility and
What is the readiness of systems and services acceptability) to validate:
to deliver the approach? Test feasibility
Clinical efficacy and cost-effectiveness
Identify barriers and enablers
Test usability of the ICOPE handbook of ICOPE approach in primary care and
through country case studies (TABLE 1B) (9) Refine outcome indicators community settings
Explore readiness through: Test clinical effectiveness
– Micro survey of health and social

care workers (TABLE 1A)
– Meso and macro survey using ICOPE

implementation scorecard (TABLE 1C)
Adoption and implementation of ICOPE: translation,
training, capacity-building, toolkit tailoring, system and
service transformation
READY-PHASE METHODS TO ASSESS ICOPE

IMPLEMENTATION READINESS
Three sub-studies, two addressing the clinical (micro) and Methodological limitations
service (meso) level, and a third focused on services and The findings in this report are intended to provide a
systems (macro), were undertaken across Member States. snapshot of implementation experiences for the WHO
At the clinical and service levels, the studies focused ICOPE approach across nominated Member States. Due
primarily on the views and experiences of health and care to the convenience sample used across the sub-studies
workers to determine the nature of the support needed for and the recognized potential for responder bias, and for
the implementation of ICOPE, including through surveys other biases inherent in the study designs, the results
and individual country case studies. The methods for each should not be interpreted as representative of a particular
study are summarized in TABLES 1A to 1C. region or Member State (including, for example, because
no low-income countries have been studied in the the
service delivery and clinical care survey). Rather, they
should be considered part of a formative evaluation of the
implementation of the ICOPE approach, derived from pilot
studies that will need further validation in larger studies
with representative sampling. The scope of the studies
was largely restricted to implementation readiness and
attitudes of the formal health and care workforce, without
the systematic engagement of informal workers, who
play an important role in the provision of person-centred,
integrated care for older people.
Design of the three-step ICOPE implementation pilot programme 11
TA B L E 1 A .
Survey of readiness at the level of service delivery
and clinical care (micro survey)
To provide an evaluation of health and care workers’ expectations about the feasibility of
A im
implementing integrated care for older people (ICOPE) in their service delivery and clinical care.
1. S
ample a multidisciplinary group of health and care workers to evaluate the feasibility of
O bjectives
implementing the ICOPE approach.
2. Identify
unique contextual considerations in implementing ICOPE according to economic
development.
Design • Cross-sectional electronic survey of health and care workers across a selection of Member States.
• Those Member States with a strong interest in implementing the ICOPE approach were identified
and nominated by WHO regional colleagues from all six regions and/or by members of the WHO
Clinical Consortium on Healthy Ageing (CCHA).
S ampling and • Convenience sample of multidisciplinary health and care workers with at least two years’
recruitment experience providing care to older people in any care setting.
• Recruitment was enabled through networks across WHO offices (including headquarters,
regional offices and country offices) and the CCHA.
D ata collection A custom survey tool was developed with input from the CCHA. (See ANNEX 1 for the English version;
eight translations were made, to Chinese, French, Indonesian, Italian, Portuguese, Russian, Spanish
and Vietnamese). The electronic survey, run between February and June 2021, had two parts.
PART 1 The first part presented a clinical case study that progressed respondents through all five steps of
ICOPE pathway (FIGURE 2 on page 7), to introduce it to respondents unfamiliar with ICOPE, before
asking them to make evaluations. At each of the following critical steps of the pathway, standard items
were presented, directed at the setting, resources, enablers and barriers:
• ICOPE screening (step 1)
• assessment of declines in intrinsic capacity (step 2.1)
• assessment and management of diseases and associated conditions (step 2.2)
• assessment and management of social and physical environments, social care and support (step 2.3)
• develop a personalized care plan (step 3)
• referral pathway and monitoring of care plan (step 4)
• engage communities and support caregivers (step 5).
PART 2 The second part had 15 items intended to assess respondents’ readiness to change clinical practice
towards ICOPE implementation. The items were structured along the COM-B model of behavioural
change (13), with four items targeting capability/capacity, six targeting opportunity and five targeting
motivation. Each item was answered along a five-point Likert scale ranging from strongly disagree to
strongly agree.
D ata analysis Data were disaggregated by country income groupings and WHO regions (ANNEX 2).
Data provided by WHO staff or respondents from non-nominated Member States were excluded, as
were those where no identification of the country was given.
TA B L E 1 B .
Country case studies of readiness at the level of
service delivery and clinical care
To assess the usability of the ICOPE handbook by reviewing data and experience from sites
A im
implementing the ICOPE approach in different health-care delivery settings.
1. A
ssess implementation readiness at the services and clinical levels in different contexts.
O bjectives
2. U
nderstand barriers and enablers to implementation, and the need for change at these levels to
support implementation.
3. G
ain some understanding of potential declines in intrinsic capacity among older people, using
ICOPE tools.
Design • Focused interviews with research teams in four pilot sites (Andorra, China, France and India) to
gather and document experiences and learning from the implementation of the ICOPE approach.
ampling and
S A convenience sample of research teams with experience in piloting the ICOPE approach was
recruitment gathered using these sampling criteria:
• teams that had proactively implemented the ICOPE approach in diverse clinical and community
settings
• teams willing to share learning from their implementation experience
• studies with local ethics committee approval.
Recruitment was enabled through the CCHA, with which all team members engaged.
D
ata collection • Data and information were collected through interviews and in correspondence with the primary
investigators and their teams to capture their experience and learning.
• Qualitative information included the preparation for studies, the implementation process,
findings and learning.
• Quantitative process and outcomes data were included for the ICOPE screening and assessment
steps while data on the later steps of the ICOPE pathway varied depending on the unique nature
and extent of each implementation pilot.
D
ata analysis • Data were thematically analysed and summarized using a structure developed for this report –
preparation, implementation, findings and learning – focusing primarily on barriers, enablers,
strengths and areas for improvement.
Design of the three-step ICOPE implementation pilot programme 13
TA B L E 1 C .
Survey of readiness at the services and systems level
(Implementation scorecard survey)
To evaluate the readiness of national health and social care services and systems to
A im
implement the ICOPE approach.
1. S
ample service- and system-level stakeholders to derive a snapshot of the capacity of health
O bjectives
and social care services and systems to implement the ICOPE approach.
2. D
etermine trends in implementation readiness of the ICOPE approach based on levels of
country income.
Design A cross-sectional electronic survey of service-level and system-level stakeholders using the
ICOPE implementation scorecard (8).
A convenience sample was gathered of stakeholders, across nominated Member States, whose
S ampling and
recruitment scope of work was relevant to ICOPE at the service and/or system level. Relevant stakeholders
included personnel from:
• national-level ministries with a portfolio relevant to health or social care for older people;
• national or subnational health or social care policy-makers, service managers or system managers;
• national or subnational civil society organizations relevant to older people;
• international, national or subnational academic associations with an interest in supporting the
implementation of ICOPE;
• WHO country offices.
Recruitment was enabled through networks across WHO offices (including headquarters, regional
offices and country offices) and the CCHA.
D • The electronic survey, running from February to June 2021, was in English, Chinese, French,
ata collection
Indonesian, Portuguese, Russian, Spanish and Vietnamese.
• The scorecard required respondents to rate the stage of implementation readiness in their
setting for nine actions at the service (meso) level and 10 at the system (macro) level, on a
three-point Likert scale from none to minimal implementation, through initiating implementation,
to sustaining it.
• The scorecard data were analysed to derive subscale scores for implementation at the two levels
D ata analysis
and a total score. Arbitrary thresholds have guided interpretation. Data were disaggregated by
country income levels and WHO regions (ANNEXES 6 AND 7).
FIGURE 5.
Health and care worker disciplines represented
by respondents to micro survey (n=260)
Others
16.2%
Medical doctors
Nutritionists
0.4%
Dentists
38.8 %
0.8% – geriatricians, 20.8%
– general physicians/primary
Health assistants
care physicians, 10.0%
1.2%
– other medical specialists, 7.7%
Pharmacists
– residents, 0.4%
1.4%
Community health workers,

including volunteers
1.9%
Nurses
Psychologists
3.5% 21.5%
Physiotherapists
4.2%
Occupational therapists
4.2%
Social care workers

5.8%
15
FINDINGS FROM THE

R E A DY P H A S E
SURVEY RESULTS: Local capacity, enablers and barriers to

adopting ICOPE in clinical settings
Readiness at level of
service delivery and The capacity of local health services to adopt the five steps
of the ICOPE pathway, and the enablers and barriers to
clinical care adoption, are summarized in TABLES 2 and 3. (Disaggregated
data by income band and region are provided in ANNEX 4.)
The micro survey had 260 complete valid responses by
health and care workers from 29 nominated Member States Respondents consistently identified the proactive
(10 lower-middle-income, eight upper-middle-income, and engagement of older people as a key enabler across all steps
11 high-income countries; see ANNEX 2, TABLE A2.1, which of the pathway, highlighting the importance of prioritizing
also shows a good spread across the WHO regions). The co-design in services and shared decision-making as key
proportions representing the country income levels across principles of the ICOPE approach. Another consistent
the total number of individual respondents are shown in theme was related to human resource capacity. First,
FIGURE 6; there were higher numbers of responses from across the steps of the pathway, respondents identified
high-income countries, representing over 57% of the total. the need for increasing local workforce capacity to be
The respondents worked across a range of disciplines, able to deliver person-centred, integrated care. Second,
most frequently from the medical and nursing professions training was highlighted as particularly crucial for screening
(FIGURE 5). They also practised across a range of settings, and assessment of declines in intrinsic capacity and, for
with a balanced distribution in primary, community and lower-middle-income countries, for the assessment and
hospital care, long-term care facilities, and home care management of environment as well as the development of
settings (see ANNEX 2, FIGURE A2.1). personalized care plans. Third, around half of respondents
did not have access to administrative support for referral and
follow-up. A range of human resource constraints, including
FIGURE 6. financial capacity and the lack of a mechanism to incorporate
Distribution by country income level of integrated care within health and care systems and services,
respondents to micro survey enabling appropriate remuneration of the worforce, was
more common than any single notable issue for respondents
in lower-middle-income countries. A range of changes and
adaptations will be needed at both the systems (macro) and
Lower middle income
services (meso) levels to address these barriers.
19.2 %
Upper middle income
23.5 %
High income
57.3 %
A number of themes emerged from responses in relation from upper-middle-income countries pointed to the
to tools and infrastructure – both as barriers and enablers. availability of the ICOPE screening and assessment tools in
A lack of infrastructure and of systems integration were local languages as an important enabler to screening, while
highlighted as potential barriers to the development of respondents from lower-middle-income countries identified
personalized care plans, and respondents from lower- the mobile ICOPE handbook app and data dashboard as
middle-income countries also highlighted a lack of digital important enablers to steps 1 to 3 of the ICOPE pathway.
integration of health information as a barrier. Respondents
TA B L E 2 .
Local needs and enablers for steps in the ICOPE care
pathway in clinical and community settings
Data shown for 260 complete and valid responses, pooled across regions and income bands
STEPS 1 2.1 2.2 2.3 3 4 5
Local needs to implement ICOPE

Need staff 34% 65% 70% 75% 72% 61% 78%
Need training 75% 70% 70% 70% 75% 64% NA
Need space 30% 40% 37% 47% 39% NA NA
Need administrative support NA NA NA NA NA 44% NA
Enablers
Support from local government 41% 35% 30% 45% 42% 30% 65%
Support from civil society organizations 31% 25% 23% 35% 35% 26% 56%
Support from academic associations such as 32% 29% 32% 37% 33% 32% 38%
medical associations
Local mechanism/system is in place for timely 32% 28% 34% 35% 34% 40% 39%
referral
Local network among multidisciplinary 49% 56% 33% 50% 54% 50% 57%
stakeholders
Training provided by local, national authorities 43% 63% 36% 40% 40% 33% NA
Availability of ICOPE screening/assessment tool 48% 43% NA NA NA NA NA

in local language
Proactive engagement of older people and their 70% 61% 57% 62% 65% 53% 65%
caregivers
Local and/or global platform to share the 30% 27% 28% 32% 30% 26% 33%
experience
Mobile ICOPE handbook app and data dashboard 43% 46% 44% 34% 38% 30% NA
Financial incentives or reimbursement for this 40% 31% 28% 32% 29% 25% 28%
activity
Access to telehealth for this activity 33% 26% 32% 23% 28% 29% 20%
Access to essential medicines NA 19% 29% 23% 23% 22% NA
Access to assistive technology NA 29% 30% 22% 30% 23% NA
Key for proportion of respondents Under 25% 25%–49% 50%–74% 75% or more
NA = not applicable
Findings from the ready phase 17
TA B L E 3 .
Barriers to steps in the ICOPE care pathway in clinical
and community settings
Data shown for 260 complete and valid responses, pooled across regions and income bands
STEPS 1 2.1 2.2 2.3 3 4 5
Additional time required 65 % 67 % 65 % 63 % 67 % 59 % 66 %
Limited space for conducting the evaluation 34 % 40 % 35 % NA NA NA NA

along with routine activities
Lack of available staff 58 % 57 % 57 % 56 % 59 % 50 % 59 %
Reimbursement for additional time and staff 37 % 35 % 35 % 41 % 39 % 34 % 40 %
Lack of knowledge and training to conduct this 47 % 39 % 39 % 40 % 37 % NA NA
activity
Lack of integration in digital information 33 % 33 % 34 % 33 % 36 % 44 % NA
platform (medical record, health record, social
care needs)
Competition, redundancy or conflict with other 14 % 14 % 14 % 13 % 17 % 17 % 13 %
health services
Reaching older people is difficult 17 % NA NA NA NA NA NA
Screening/assessment tool needs to be adapted 33 % 27 % NA 30 % NA NA NA

to local context
Lack of infrastructure and system to provide NA NA NA 33 % 52 % NA NA

integrated health and social care
No information on community activities NA NA NA NA NA NA 37 %
No, I do not see any barriers 6 % 8 % 11 % 8 % 9 % 17 % 10 %
Key for proportion of respondents Under 25 % 25 %–49 % 50 %–74 % 75 % or more
NA = not applicable
STEP 1 ICOPE screening
STEP 2.1 In-depth intrinsic capacity assessment
STEP 2.2 Assessment and management of diseases
STEP Assessment and management of social

Respondents consistently
2.3
and physical environment
identified the proactive STEP 3 Develop a care plan
Follow-up and referral

engagement of older people STEP 4
STEP 5 Community engagement

as a key enabler across all
steps of the pathway
Attitudes towards implementing ICOPE
Respondents’ attitudes towards ICOPE and its LEARNING

implementation are summarized in TABLE 4 across five
domains. (Disaggregated data by income band and region The results from the surveys with health and care
are provided in ANNEX 5.) workers highlighted:
Respondents overwhelmingly expressed positive attitudes strong engagement with, and support for,
towards the ICOPE approach, with 98% agreeing or strongly the ICOPE approach
agreeing that integrated care is important to promoting the
need for clinical- and service-level support for
maintenance of, and preventing declines in, the intrinsic
implementation, modifications to care workflow
capacity and functional ability of older people. Some 95%
(e.g. staff time, staff reimbursement) and
also stated the need to change current practice to the
investment in workforce capacity-building
provision of person-centred integrated care. However,
almost 60% of respondents identified that integrated care
importance of community engagement to
was more time-consuming, complex and challenging than
support all steps of the ICOPE pathway
the care currently provided.
critical role of co-design in service delivery
These observations highlight the positive attitudes and and shared decision-making for person-
beliefs of the respondents and the importance of creating centred care
enabling environments to deliver person-centred integrated
care, but also the barriers currently faced, pointing to potential of digital tools to support integrated care
a need for change at the systems and services levels.

establishment of local networks of multi-
Enabling environments resonate with respondents, strongly
disciplinary stakeholders as an important enabler
supporting the:
• need for systems and services support to implement

the ICOPE approach;
• need for training to build workforce capacity;
The importance of community

• added value of digital tools such as the ICOPE handbook
app and data dashboard to support service delivery; engagement to support all steps of
the ICOPE pathway was identified,
• i mportance of community engagement and support
for ICOPE implementation, which can take a number
reinforcing the critical role of
of forms, including the use of community spaces and co-design in service delivery and
events to deliver ICOPE screenings and awareness shared decision-making for person-
raising of the importance of maintaining intrinsic
capacity and functional ability by community leaders,
centred care
groups and volunteers.
These trends were observed irrespective of country income

levels and regions.
TA B L E 4 .
Attitudes towards implementation of ICOPE and
changes required to clinical practice
STRONGLY DISAGREE NEUTRAL AGREE STRONGLY

DISAGREE AGREE
Attitudes towards ICOPE

Care that is integrated and person-centred is important to promoting < 1% 0 < 1% 20% 78%
the maintenance of, and preventing declines in, the intrinsic capacity
and functional ability of older people
I believe it is necessary to change current practice to the < 1% 1% 3% 23% 72%

person-centred integrated care model
The assessment of social and environmental needs for older people is 31% 38% 15% 10% 6%
not my practice’s responsibility
The assessment and management of underlying diseases and 4% 9% 17% 35% 35%
disorders is my standard practice
Care that is integrated and person-centred is more time-consuming, 7% 14% 19% 37% 22%
complex and challenging than my current day-to-day practice
ICOPE will help older people and their caregivers to engage 0 1% 6% 40% 53%
proactively in their health care
Systems and services support to implement ICOPE

Extra reimbursement to my practice for following ICOPE would make 2% 4% 18% 35% 42%
it more feasible to implement
A directive from the local health system or national authority (e.g. 0 1% 8% 39% 52%
ministry of health) to implement ICOPE would help to change practice
Streamlined systems for the referral of older people will be important < 1% 0 4% 36% 60%
for ICOPE implementation
Workforce capacity-building
I would feel more confident implementing ICOPE if I and my staff had < 1% 1% 8% 41% 49%
access to online training tools in our local language
Digital infrastructure support

Digital tools like the ICOPE handbook app will need to communicate 0 < 1% 9% 38% 53%
and integrate with existing medical records (electronic or traditional)
Digital tools like the ICOPE handbook app will be key to help with < 1% 3% 15% 45% 37%
implementing ICOPE in my practice
Community engagement and support

Support from health experts and professional bodies (e.g. medical 2% 7% 15% 44% 33%
colleges) will be needed to implement ICOPE in my setting
Support from civil society and local community organizations will be < 1% 3% 12% 46% 38%
needed to implement ICOPE in my setting
A media campaign in my local area about the positive impact of < 1% < 1% 8% 40% 50%
ICOPE on older people’s health and well-being will help with engaging
older people and encouraging my staff
Key for proportion of respondents Under 10% 10%–24% 25%–49% 50%–74% 75% or more
COUNTRY CASE STUDIES: Preparation and adaptation

Readiness at level of of ICOPE
service delivery and At all the study sites, the preparation phase focused on:
clinical care • adapting or developing the ICOPE tools to be used
during implementation;
The country case studies focused primarily on the pilot
study of ICOPE at the clinical (micro) level and assessed • recruiting health and care workers and older people
the usability of the ICOPE approach within existing clinical to participate in the studies;
settings and services (meso). Case studies provide real-world
• training health and care workers and building
insights into the implementation of the ICOPE approach,
partnerships across sectors.
including engagement with health and care workers and
older people.
The WHO ICOPE tools for health and care workers,
available in nine languages, include the ICOPE handbook
This section describes the experiences in four settings
on person-centred assessment and care pathways (9) and
during preparation and implementation, and shares the
the ICOPE handbook mobile app. One of the first steps
findings and learning based on ICOPE pilots conducted in
for each of the study sites was to review these tools to
Canillo in Andorra, Chaoyang in Beijing, China, Occitanie in
determine whether any adaptations were needed to suit
France and Jodhpur District, Rajasthan in India (14). The map
their context, or to enable the collection of information
on page 22 summarizes the study site characteristics and
needed to meet the study objectives. BOX 1 summarizes
the participants involved in these four case studies.
the adaptations made, including by developing
supplementary digital tools.
Case studies provide real-world

insights into the implementation
of the ICOPE approach, including
engagement with health and
care workers and older people
21
BOX 1:
Adaptation and augmentation
of ICOPE tools
Each of the four sites made some adaptations to the tools for integrated care for older people
(ICOPE) for their contexts. In Canillo, Andorra, for example, the WHO ICOPE handbook app and
dashboard, in Spanish, were used with additional functional health assessments such as a sleep
scale. The paper-based handbook was used in Rajasthan, India, with added assessment for
items, including self-reported health status, underlying conditions, social support, caregivers
and risk of elder abuse.
DIGITAL TOOLS
The studies in Chaoyang and Occitanie included the following
augmentations developed for the ICOPE digital tools.
CHAOYANG :
• Local mobile app for the screening step, for use both by
health and care workers and, for self-screening, by older
participants
– Video explainers on completing screening
– Audio clips for hearing impairment screening
• Local ICOPE data dashboard to collect and analyse data gained

from screening and assessment
• Artificial intelligence system to support the design and delivery

of personalized care plans
OCCITANIE :
• “ICOPE Monitor” mobile app for screening (19)

– To collect longitudinal data from screening every six months
• “ICOPE Bot” online tool for screening (20)

– Mobile phone, tablet or laptop use
– Conversational robot to guide through the screening process
• FRAILTY-ICOPE database
– For storing, reviewing and analysing data
– Access to data on participants’ status, risks and follow up
– Generates alerts for health workers
THE 4 STUDY SITES
CANILLO (ANDORRA)
July
to September 2020
The
study team comprised two geriatricians and
a geriatric nurse. It also engaged primary care doctors
to ensure follow-up care
S
mall urban site
• Small town in mountainous area

• 18% of 4 422 population aged 60 years and over (15)
• 798 over 60 years: 18%
• 523 over 65 years: 12%
7
2 participants
• Mean age, 73 (65–92 years) RAJASTHAN (INDIA)

• 54% female
January to May 2021
Fifteen public health students were trained to

implement the screening step of ICOPE
Rural site
• Two villages in the Jodhpur district of Rajasthan

• 8% of 69 million population aged 60 years and over (18)
4 51 participants
• Mean age, 68 (65–98 years)

• 46% female
OCCITANIE (FRANCE)
O ngoing since January 2020 (Data to November 2021)
1 711 health and care workers, 410 nurses
L arge urban site
• Primarily in Toulouse city

• 30% of 6 million population aged 60 years and over (17)
10 903 participants
• Mean age, 76 (18–108 years with 96% aged 60 or more)

• 61% female
CHAOYANG (CHINA)
Ju ne 2020 to August 2021
Over 22 000 health workers, including primary care

physicians, nurses, rehabilitation therapists and
social workers, and over 200 partner organizations
and facilities
L arge urban site
• Largest district in Beijing city

• 21% of 3.45 million population aged 60 years and
over (16)
874 participants
• Mean age, 82.8 (70–100 years)

• 61% female
RECRUITMENT OF OLDER PEOPLE RECRUITMENT OF HEALTH AND CARE

WORKERS AND COLLABORATING PARTNERS
Each of the four sites took a tailored approach to efforts to
engage and encourage older people to participate in the The following points summarize how efforts were made in the
implementation pilot. case studies to recruit the health and care workers who would
implement the ICOPE care pathway steps and help to pilot the
• The study in Canillo used a rolling recruitment process approach.
that followed a public health media campaign. The
participants were screened and assessed as they were • The study team in Canillo comprised two geriatricians and
identified. a geriatric nurse. It also engaged primary care doctors to
ensure follow-up care.
• A multimedia campaign through both traditional and
social media was used at the Chaoyang site to recruit • The multimedia campaign used to recruit participants
older participants. in Chaoyang also targeted health and care workers (it
reached some half a million people in total). This case
• Older people having the opportunity to be centrally study also proactively engaged health centres and
involved in their own care was a key message of the professional associations. Over 22 000 health workers,
campaign in Occitanie to encourage participants to self- including primary care physicians, nurses, rehabilitation
screen. This engagement and recruitment was achieved therapists and social workers, showed interest in
through a multimedia campaign using flyers, posters, a the study, and the team engaged over 200 partner
film promoting the ICOPE Monitor mobile app, webinars, organizations and facilities.
conferences and interviews.
• A campaign promoting the ICOPE digital tools to health
• The collaborating rural health centre in Rajasthan workers in Occitanie led to nearly 2 500 downloading
identified participants with the help of a word-of-mouth content, including 906 nurses, 566 doctors, 230
approach driven by members of the older community pharmacists and 156 physiotherapists.
taking part in the recruitment strategy. ICOPE was viewed
as a way for older people to access care tailored to their • The team in Rajasthan worked with students at the school
specific needs, something they had not seen before. of public health with existing responsibilities in community
health. The school was a collaborating partner in the pilot.
Over 22 000 health workers,

including primary care physicians,
nurses, rehabilitation therapists and
social workers, showed interest in
the study in Chaoyang
TRAINING OF HEALTH AND CARE WORKERS
The following summarizes the broad approaches taken to OCCITANIE

ICOPE training at each case study site, and the numbers and
• ICOPE concept and step 1 of the pathway for 1 711 health
types of trainees involved, determined by the scale of the pilot.
and care workers:
– 1 053 nurses, 245 pharmacists, 104 doctors, 20 post
CANILLO
office workers
In this case, the team was small and already had awareness of – 40 minutes online, offered two to three times a
ICOPE, so it needed minimal training. month
• ICOPE steps 2, 3 and 4:

CHAOYANG
– twice yearly for 410 nurses
• Basic familiarization: 22 705 health and care workers were
sent: RAJASTHAN
– articles explaining ICOPE and the implementation pilot
• Fifteen public health students were trained to implement
– links to ICOPE tools and the World report on ageing and
the screening step of ICOPE.
health (in Chinese) (2)
• ICOPE seminars for 5 300 community health workers:

– ICOPE and study background, aim, key concepts and
approaches
– using the digital screening and assessment tools, care
pathways, and reporting
– protecting information and privacy
• Integrated care manager training for 431 health and care

workers:
– 217 nurses, 186 community doctors, 28 rehabilitation
therapists, three geriatricians
– all steps of the care pathway
– how to be the link between providers, services and
systems
An integrated care manager/nurse assessing

mobility as part of the person-centred
assessment in the ICOPE approach. Pilot site
in Chaoyang District, Beijing, China.
Photo credit: Pinetree Care Group, China

Implementation Canillo: The team undertook an assessment of declines in

intrisic capacity with all participants, irrespective of their
screening results. This was conducted at the community
While all four research teams aimed to implement all the steps
health facility.
of the ICOPE care pathway directly, this was not always feasible.
Some built partnerships outside of those directly engaged in
Chaoyang: Assessments were carried out by integrated
the study, to ensure referrals could be made to other providers
care managers with all participants, irrespective of their
who were able to be involved in the later steps of the pathway.
screening result
BOX 2 illustrates the extent to which the sites engaged in
numerous partnerships to help with various elements of ICOPE
Occitanie: The assessments were organized and
implementation.
conducted by the primary care workers (physicians, nurses,
physiotherapist) with participants who had a positive
screening result in intrinsic capacity, at a health facility, or
STEP 1 SCREENING FOR DECLINES IN
the participant’s home, and using digital tools.
INTRINSIC CAPACITY
ICOPE screening, to detect potential declines in intrinsic

STEPS 3 4 5 CARE PLANS, REFERRAL,
capacity, was the priority for all four studies. The study teams
MONITORING AND COMMUNITY
reported that the screening sessions took between five and
ENGAGEMENT
20 minutes per person. The setting for this screening was:
Canillo: The team met with all participants to discuss the

• a social club for older people run by the city council in
results of their screening and assessment. Any person with
Canillo (two geriatricians and one geriatrics nurse);
a decline in mobility or cognition received an appointment
with the lead geriatrician, to develop a personalized care
• the homes of older people, and health centres in
plan then shared with the participant’s primary care doctor.
Chaoyang and Occitanie (431 integrated care managers
and 724 health workers respectively, and some self-
Chaoyang: After developing personalized care plans with
screening for follow up, periodic screening after an initial
older people, integrated care managers (trained health and
screening conducted by a health or care worker);
care workers) provided follow up sessions mainly through
video calls. These aimed to support rehabilitative exercises,
• the homes and the community in Rajasthan (15 public
medication adherence and assistive care, and to check for
health students).
any new or additional needs for social and health services.
Occitanie: development of care plans and any necessary follow

STEP 2 ASSESSMENT OF DECLINES IN
up were referred to the primary care workers. The study at the
INTRINSIC CAPACITY, UNDERLYING
Occitanie in France has reported the numbers of participants
DISEASES, AND NEEDS FOR SOCIAL CARE
receiving referrals to care among those 958 older people for
AND SUPPORT
whom data were uploaded in the FRAILTY-ICOPE database from
the step 2 assessment. The team provided recommendations
• The studies in Canillo, Chaoyang and Occitanie
and interventions to 374 participants (39%) for vision, including
included in-depth assessments after the ICOPE
referring them to comprehensive eye care; 623 people (65%)
screening. In Rajasthan, assessments were planned
on cognition, such as by referring them to a memory clinic or
but, due to COVID-19, no further activity was possible
for cognitive stimulation; 396 (41.3%) for hearing care, including
following the screening step.
providing hearing aids; 838 older people (86.4%) on mobility, such
as referring them to physiotherapy; 740 (77.2%) on nutrition, with
dietary advice for example; and to 429 participants (44.8%) on
mood, including to give them advice on their social environment.
BOX 2:
Building partnerships in local networks
Having multisectoral involvement and using multidisciplinary teams are critical factors for the ICOPE
approach. The case study teams built partnerships across the health and care sectors to support
implementation. The roles of partners included providing funding for the research and implementation of
ICOPE through insurance payments, supporting with recruitment of workers and participants, supporting
training for health and care workers, and providing referral and follow up care. The four studies involved the
following array of partner organizations for multisectoral, multidisciplinary implementation.
C A NILLO (A NDOR R A) R A J A S TH A N (INDI A)
Ministry of Health; City Council of Canillo; national All India Institute of Medical Science; Asian Centre for
health-care system; older people’s social clubs Medical Education, Research and Innovation; Rural
Health Centre of State Medical and Health Services;
CH AOYA NG (CHIN A) : Community leaders
Ministry of Civil Affairs; National Health Commission;

National Healthcare Security Administration; National
Committee on Ageing; National Research Centre
on Ageing; Beijing Bureau of Civil Affairs; Beijing
Health Commission; Beijing Healthcare Security
Administration; Chaoyang Elderly Care Service Centre
Nineteen hospitals in Beijing; 109 health

centres; 12 older people’s care stations run
by the government and 25 run by civil society
organizations; WHO China office
OCCITA NIE (FR A NCE )
Regional Union of Health Professionals; University

Department of General Medicine; Occitanie
Roussillon Federation of Healthcare Homes;
multi-professional health homes; Information and
Prevention Centre; Health Insurance Examination
Centre; Postal Service; Haute-Garonne Departmental
Council; Pension and Occupational Health Insurance “Thanks to ICOPE, I feel
Fund; National Old Age Insurance Fund; several empowered to continue this
territorial professional health communities; town
way in order to preserve my
halls; seniors’ residences
health in the future.”
Austruy Micheline, ICOPE participant, France
Findings The screening results from Occitanie suggest potentially

high levels of decline across numerous conditions associated
STEP 1 SCREENING with declines in intrinsic capacity. Ninety-four percent of
participants had potential declines in at least one condition
Across the four study sites, all older participants were and there were also high numbers of participants experiencing
provided with at least one ICOPE screening, and in Chaoyang declines in multiple conditions simultaneously (FIGURE 7).
and Occitanie, follow-up screening was also conducted.
The results of the first screening, shown in TABLE 5 on page
29, suggest the greatest risk of a decline in capacity is in the F I G U R E 7.
vision domain. Caution is needed in the interpretation of this
Number of conditions associated with
result, though, as a discrepancy was identified in whether
the screening related to corrected or non-corrected vision. declines in intrinsic capacity, identified
30%
In both Canillo and Occitanie, screening identified potential by ICOPE screening (in Occitanie)
declines in cognition, with both identifying possible cases
among more than 50% of the people in their cohorts. In
25%
both the mobility and mood domains, there were declines
detected in over a quarter of the older participants in three
out of four sites. In Rajasthan, the screening suggested the 20%
most significant declines were in hearing and mobility, both
scoring over 50%. Sex disaggregated data from the study
in Rajasthan show higher levels of decline in the mobility 15%
domain among female (55%) than male (42%) participants.
10%
5%
0
0 1 2 3 4 5 6
Number of domains
94% of participants in Occitanie

had potential declines in at least
one condition
“The ICOPE programme
helped us to see a lot of
things at one go, instead of
having to visit the various experts.”
Coraline Fetherstonhaugh, ICOPE participant, Andorra
In Occitanie, assessments were recommended for those with

STEP 2 IN-DEPTH ASSESSMENT OF
a positive screening result. The data included from Occitanie
DECLINES IN INTRINSIC CAPACITY
are for a subset of participants whose results were uploaded by
their primary care doctor into the FRAILTY-ICOPE database.
For the three sites undertaking in-depth assessments of
intrinsic capacity, the findings against domains are shown
Across all three sites, a third of older participants were found
in TABLE 6. In Canillo and Chaoyang, assessments were
to have cognitive decline. Nearly two thirds in Occitanie had
conducted with all participants, irrespective of screening result.
a loss of mobility and over 40% had issues with malnutrition.
There were differences between the screening and assessment
Differences were seen between the sites in terms of depressive
results in these contexts; for example, 14% of respondents
mood, with more than one in three experiencing this in Canillo
in Chaoyang showed potential cognitive decline at screening
and Occitanie, compared with only 5.5% in Chaoyang.
compared with 37% at assessment, highlighting a need for
revision of the ICOPE screening tool. The validation of the ICOPE
screening tool in different populations is one of the objectives
of latter phases of the pilot programme.
TA B L E 5 .
STEP 1 : cases of potential decline in intrinsic capacity
Rate of positive cases (%)

Condition associated
with decline in capacity C ANILLO CHAOYANG OCCITANIE R AJA S THAN
(N=72) (N=874) (N=10 903) (N= 451)
Cognitive decline 56 14 60 32
Loss of mobility 24 31 35 52
Visual impairment 82 45 68 49
Hearing loss Not included 20 51 68
Malnutrition 17 16 19 34
Depressive mood 39 26 38 19
TA B L E 6 .
STEP 2 : cases of decline in intrinsic capacity
from the three sites that did step 2 of the care pathway
Rate of positive cases (%)

Condition associated
with decline in capacity C ANILLO CHAOYANG OCCITANIE
(N=72) (N=874) (N=958*)
Cognitive decline 39 37 44
Loss of mobility 29 18 66
Visual impairment 17 5 29
Hearing loss Not included 21 30
Malnutrition 17 33 41
Depressive mood 36 6 39
Primary care doctors were responsible for these assessments but were not required to enter the results into the
FRAILTY-ICOPE database, so the number of participants who went on to have a full assessment is not known for Occitanie.
Results data were entered for 9.3% of those identified at the screening step
An integrated care manager/rehabilitation

therapist coaching an ICOPE pilot participant
to complete daily physical exercises at
his home in Chaoyang District, Beijing, China.
Photo credit: Pinetree Care Group, china
31
Outcomes of • At the end of the study in Chaoyang, 99% of participants

said they would be willing to continue with the piloting over
ICOPE implementation the longer term and 63% said they were more satisfied
with their health than they had been a year before. Of over
ACCEPTABILITY AND SATISFACTION WITH 1 000 older participants in Occitanie, nearly 80% were
THE ICOPE APPROACH satisfied with the ICOPE digital tools and 64% said they
were useful.
The studies in Chaoyang and Occitanie reported how well

received the implementation was for participants. The team • Responses to self-reported questions in Chaoyang
in Rajasthan did not undertake any formal assessment of suggested participants felt empowered by gaining more
satisfaction but had anecdotal evidence to suggest a good level knowledge about their health and care, and felt they had
of buy-in and enthusiasm for ICOPE. Informal conversations better symptom control. They also reported reduced
suggested that older people here were encouraged to see hospital visits, better communication with doctors and
interventions being designed specifically to meet their needs, improved adherence to medication. In Occitanie, 70%
and they welcomed the opportunity to speak and to be heard. said they felt that their engagement with ICOPE had
Similarly, the team in Canillo did not undertake an assessment helped them to better understand their own physical
of satisfaction, but received positive feedback from participants and mental capacities and needs.
who thanked the geriatricians and nurse in the research team

for the comprehensive ICOPE assessment, with many also
recommending their peers engage with the study. EFFECTIVENESS AND IMPACT OF THE
ICOPE APPROACH
Older people in Rajasthan • There has been some effort by the study teams in
Chaoyang and Occitanie to evaluate the effectiveness
felt encouraged to see of the ICOPE implementation on participants’ health and
interventions being designed well-being. With the short follow-up (around one year), it
is too soon to reach conclusions on the effectiveness and
specifically to meet their systems impact of the ICOPE approach, including in the
prevention of care dependency. In Chaoyang, preliminary
needs, and they welcomed the results indicate, however, the effectiveness of the approach
in the management of chronic conditions, improving
opportunity to speak and to activities of daily living and mental health and reducing the
be heard use of health care (e.g. hospital visits).
At the end of the study in

Chaoyang, 99% of participants
said they would be willing to
continue with the piloting over
the longer term
LEARNING
Enablers
ENGAGEMENT OF OLDER PEOPLE PARTNERSHIPS UNDERPIN SUCCESS IN
IMPLEMENTING ICOPE
All teams stressed the importance of older people’s
participation as a crucial enabler for ICOPE implementation. A range of partnerships developed to support ICOPE
Different approaches were taken to raising awareness and implementation is listed in BOX 2 on page 27. The teams
gaining the support of older people. This highlights that in Canillo and Chaoyang highlighted the importance of
there is no one-size-fits-all approach and that, rather, the building strong links with multiple stakeholders, and in
key is to rely on local experiences and approaches that particular the government, crucial to the study in Chaoyang,
resonate with communities. where the Government provided funding for the pilot. In
Occitanie and Rajasthan, the status and reputation of the
• Community-level discussion generated through word lead organization was critical to the establishment of key
of mouth has gained public acceptance of the study in partnerships for implementation. In the former case, this
Canillo, and secured the interest of older participants. has led to resources being leveraged, and commitments
made to the forthcoming phases of ICOPE implementation
• Mass media campaigns were a key enabler in not scale up. In the latter case, the reputation of the Rajasthan
only securing the positive engagement of older team and its existing community relationships were key to
participants but also a wide range of health and care the delivery of the pilot. The students in public health were
stakeholders in Chaoyang. A similar approach also also already well trusted.
proved successful in Occitanie.
• Older people actively sought to be involved in the DIGITAL INFRASTRUCTURE

study in Rajasthan after hearing about it from peers.
Interest appeared to be driven by a desire among Technology may be a useful enabler of ICOPE
older people to be listened to, and to feel they were implementation.
being proactively targeted and prioritized by the
health and care systems. • The use of telemedicine in Occitanie enabled
nurses to support older participants to monitor their
intrinsic capacity through follow-up screening and
by responses to alerts generated through the ICOPE
Monitor app and the FRAILTY-ICOPE database.
• Online screening and follow-up were also cited as

an enabler by the team in Chaoyang, particularly in
the context of the restrictions to in-person contact
caused by COVID-19.
“The evaluation helped me a lot. I realized

the necessity of health checkup and need to take
care of my health in future.”
Mangi lal, ICOPE participant, India
Barriers and challenges

HUMAN RESOURCE CONSTRAINTS WORKFORCE ATTITUDES, KNOWLEDGE
AND SKILLS
A consistent barrier highlighted by all the study teams
was human resource constraints, both in terms of the A shared barrier in Occitanie and Rajasthan was the
number of health and care workers, and the time they limited knowledge of, and limited interest in, older
were able to give to implement the ICOPE care pathway. people’s care among health and care workers. The
The extent and nature of this challenge differed across Occitanie team highlighted a lack of awareness among
sites. primary care doctors about the opportunities to support
older people to change the trajectories of their intrinsic
• The small team responsible for implementation in capacity, to slow decline.
Canillo had time constraints.
• The ratio of integrated care managers to participants FINANCING CONSTRAINTS TO SUPPORT

was low in Chaoyang, making it difficult for them IMPLEMENTATION RESEARCH AND
to deliver effectively. This was further exacerbated SCALE-UP
by the small number of primary care doctors
available to support the more complex cases, and Financial barriers to implementation were also
the challenges to engage specialist health workers highlighted by the teams in Rajasthan and Occitanie.
outside of geriatrics. This was a shared challenge despite the different scales
of the studies and resource settings. The study in
• Primary care doctors in Occitanie were observed to Rajasthan was implemented without any stand-alone
lack both the time and the reimbursement to be able funding, limiting its size and challenging the ongoing
to support ICOPE assessments and interventions. phases of implementation. In Occitanie, the lack of
financial incentive within the health system to integrate
ICOPE interventions with other health interventions was
cited as a particular barrier to scale-up, especially for the
latter steps of the pathway (only the screening step was
covered by health insurance).
All teams stressed the
importance of older
COVID-19
people’s participation as a
crucial enabler for ICOPE A consistent challenge across the sites was the disruption
caused by the COVID-19 pandemic. This had an impact on
implementation the delivery of the care pathway, the availability of health
workers and services to support implementation and the
timeframes in which the studies could be delivered. Some
older people were also more reluctant to engage with the
study due to concerns about their potential exposure to
COVID-19.
LEARNING (cont.)
Improvements Strengths
Based on their experiences of implementation, the OPPORTUNITY TO EMPOWER OLDER
study teams highlighted the following areas for possible PEOPLE
improvement in the ICOPE approach.
The engagement of older people was identified not only
• The Canillo team suggested: as an enabler of ICOPE, but the approach was also found
to promote empowerment and increased knowledge.
– modification of the ICOPE screening tool to
increase its specificity and sensitivity, for example
• Older participants highlighted a greater sense of
supporting cognition screening through the
self-empowerment in the Canillo case study, and the
inclusion of another test in step 1, such as asking
team identified strengths in the holistic and proactive
the older person to draw a clock;
nature of ICOPE, and in its role to prevent declines in
intrinsic capacity and functional ability.
– modifications to the data dashboard, simplifying
it for the benefit of users with limited capacity
• The detailed assessments that led to older
using information technology, and increasing the
participants and caregivers being supported and
functionality to support summarized and visual
coached in the development of personalized care
data.
plans were found to be beneficial for older people’s
knowledge and demand for services in Chaoyang.
• The Chaoyang team suggested:
– changes to address sustainability and scalability, • In the Rajasthan case study, screening was found
including advocacy to ensure national funding and to help raise awareness among older people of their
a standardized accreditation system for training health and care needs.
and the integrated care manager role;
• Building an understanding of what intrinsic capacity
– cost-effectiveness analysis.
was, and how decline could happen and be
prevented or slowed, led to a sense of empowerment
• The Occitanie team suggested addressing problems
among the participants in Rajasthan.
with the usability of digital tools.
• Also in the Rajasthan study, where older people

• The Rajasthan team suggested further thinking
had previously accepted declines as a “natural part
on how to support the level of resourcing needed
of ageing” and had not sought services and support,
to implement ICOPE in resource-constrained
the change in understanding suggested a shift in
environments.
health-seeking behaviour. This finding was based on
the observations and would warrant more formal
evaluation as the pilot continues.
HEALTH WORKFORCE CAPACITY- DIGITAL IMPLEMENTATION

BUILDING
The general approach of digitizing ICOPE and using
• The exposure of health workers to assessing declines technological solutions was perceived as a strength, albeit
in intrinsic capacity with an ability to monitor these with some improvements needed on specific aspects.
through the FRAILTY-ICOPE database was important In Chaoyang, for example, more than three quarters
to the team in Occitanie, given that health and care of participants were positive about their experiences
workers generally had not previously been aware of with telephone consultation and coaching, and many
the different conditions of intrinsic capacity, and had highlighted the benefits of video-based physical exercise
had no way to observe changes. therapies provided by integrated care managers online.
The ability to deliver screening using the digital tools
• This opportunity to fill a knowledge gap on integrated was highlighted by the Occitanie case study, as was
care for older people was also a strength highlighted the possibility of supporting health worker engagement
by the Rajasthan team. through the FRAILTY-ICOPE database.
COORDINATION AND COLLABORATION

BETWEEN HEALTH AND CARE WORKERS
AND SYSTEMS
In addition to health and care worker capacity-building, the

studies highlighted the role ICOPE can play in encouraging
coordination and collaboration between workers and
between the stakeholders in the health and social care
systems, including local and national government.
• ICOPE supports improved communication between

health and care workers, and between older people
and health and care workers, according to the Canillo
team.
• The study in Chaoyang demonstrated the importance

of having specific human resource capacity in the form
of integrated care managers. The strength of the role
was its focus on coordination between disciplines and
systems, thereby countering fragmentation.
“I was happy with the pilot.

• A large network of health professionals across cadres
in Occitanie supported collaboration and a more For my wife, be it nursing
integrated approach to care.
care, or seeking advice, there
is hope now.”
Haizhen Ren, ICOPE participant, China
36
SURVEY RESULTS:
Readiness at the services
and systems level
The services and systems-level survey using the ICOPE implementation
scorecard had 259 complete valid responses from 35 nominated Member
States (1 low income, 11 lower-middle-income, 12 upper-middle-income,
and 11 high-income countries; listed in ANNEX 3 TABLE A3.1)
Respondents represented Member States across all levels of economic
development, but with higher response rates from high-income settings
(FIGURE 8), and most frequently represented national or subnational
ministries of health (FIGURE 9).
FIGURE 8.
Distribution by country income level of
respondents to services and systems survey
Lower Income
2.7%
High Income
47.1%
Lower Middle Income
22.0%
Upper Middle Income
28.2%
FIGURE 9.
Sectors represented by respondents to services
and systems-level survey
Other Civil society organizations

15.4% 10.8%
WHO staff Academic associations
5.4% 7.7%
Local policy-makers Health service managers
(e.g. municipality) 4.2%
5.0% Ministries of health
30.5%
Health system managers

9.7%
Other ministries in
national government
2.3%
Ministries of public health
3.1%
Ministries of social affairs
5.8%
Readiness by country readiness overall and also against the identified collective
actions within services and systems that would facilitate the
income levels and regions implementation of ICOPE. Looking at the overall average
scores, high-income and upper-middle-income countries
Scorecard ratings for implementation readiness at the services, fell within the “initiating implementation” range while those
systems and overall levels used the scoring ranges set out by the in the two lowest-income brackets scored in the “no to
implementation framework for policy-makers and programme minimal implementation” range. Across all countries, there
managers (8), as given in FIGURE 10. was a large range of scores, suggesting that implementation
readiness is context-specific. Irrespective of economic
As FIGURE 11A shows, readiness varies across the levels of development, implementation readiness was higher on
economic development indicated by country income bands average for services than for systems FIGURE 11B.
(see ANNEX 6 for the data disaggregated by WHO region).

On average, countries with higher incomes reported more
FIGURE 10.
Scorecard ratings used in the framework
measure of ICOPE readiness
No to minimal level Initiating Sustaining

implementation implementation implementation
Service-level
implementation 0-10 11-18 19-26
readiness
System-level
readiness
Overall
readiness
UMIC
Findings from the ready phase LMIC

39
LIC
0 5 10 15 20 25 30 35 40 45 50 55
FIGURE 11. Service and system implementation

readiness score (0-26)
Implementation readiness by country income groupings
Pooled service
HIC = high-income country, LIC =system

Pooled low-income country, LMIC = lower-middle-income country,
UMIC = upper-middle-incomeHIC
country
service
HIC system
Surveys of a total of 35 Member States with 259 respondents. The median scores with the first and third quartile are
presented as a box with barsUMIC service
(minimum and maximum scores).
UMIC system
FIGURE 11A. LMIC service
LMIC system
Pooled LIC service
LIC system
HIC 0 5 10 15 20 25 30
UMIC
LMIC
LIC
0 5 10 15 20 25 30 35 40 45 50 55
Total Implementation readiness score (0-52)
F I G U R E 1 1 B . Median score in WHO regions
Services
Pooled
Systems
HIC
UMIC
LMIC
LIC
0 5 10 15 20 25 30
Service and system implementation readiness score (0-26)
Readiness by specific countries tended to report more readiness than lower-

resourced ones. These findings highlight the importance of
actions in support of considering:
ICOPE • local meso- and macro-level contextual factors for

implementation;
The results on implementation readiness by scorecard
themes for systems and services are displayed in the charts • the need for more overall, comprehensive
in FIGURE 12, giving both the pooled results and those implementation support for lower-resourced settings.
by country income levels (disaggregation by WHO region is
given in ANNEX 6). ANNEX 7 summarizes implementation Across all countries and regions, notable gaps in
readiness by individual actions, considering each of the 19 implementation readiness were identified for orienting
actions independently. services towards community-based care as well as
strengthening governance and accountability systems.
For each of the three themes of service actions about For lower-resourced settings, supporting the coordination
empowerment, multidisciplinary coordination and of services delivered by multidisciplinary providers and
community-based care (FIGURES 12A to 12C), system strengthening were identified as areas for greater
around a third of respondents identified no to implementation support. This suggests that greater attention
minimal implementation, another third were initiating to the development of community-based service delivery
implementation and the remainder cited sustaining models – with capacity-building and integration across health
implementation. Overall, the greatest implementation and care workers – is needed for the ICOPE approach to be
readiness was associated with the service action to “actively sustained in community and primary care settings.
engage older people, their families and caregivers and
civil society”, while the least was with “deliver care that is Member States showed the most implementation readiness
acceptable to older people, effective and targets functional on community engagement and the co-design of services,
ability” (ANNEX 7). highlighting progress in the acceptance of ICOPE and
community engagement in healthy ageing. Low systems
For the system-level strengthening actions (FIGURES readiness related to service-level capacity in monitoring
12D and 12E), for both themes of system actions and the adoption of digital technologies to support self-
about governance and accountability, as well as system management points to the need for investment and
strengthening, respondents from low-income countries infrastructure for the relevant systems-strengthening activities.
reported no implementation. Overall, the greatest
implementation readiness was associated with the system
action to “develop capacity in the current and emerging
workforce to deliver integrated care”, while the least was with
“use digital technologies to support older people’s
self-management” (ANNEX 7).
For the ICOPE approach to be
sustained in community and
Across the Member States involved in the scorecard survey,
implementation readiness for the ICOPE approach varied
primary care settings, greater
substantially. Higher levels of readiness on average were attention to the development
seen at the meso level, in health and social care services,
of community-based service
compared with the macro, systems, level. High-income
delivery models is needed
FIGURE 12. By country income levels (%)

Total income High income
Implementation readiness for three service-level
N=259 N=122
themes and two system-level themes21
By country income levels (%) 3

4
FIGURE 12A. Total income FIGURE 12B.
5High income Upper middle income Lower m
Engage and empower people and communities
N=259 Coordination of services delivered
N=122 N=73 by
6
multidisciplinary providers
1 7
Pooled 2 8
Pooled
3 9
HIC
4 10
HIC
5 11
UMIC 6 12
UMIC
7 13
LMIC 8 14
LMIC
9 15
LIC 10 16
LIC
11 17
0 20% 40%
12 60% 80% 100% 18 0 20% 40% 60% 80% 100%
13 19
14
0 50% 100% 0 50% 100%
15
FIGURE 12C. 16
17
community-based care Services Systems
18 None to minimal implementation None to minimal
19 Initiating implementation Initiating implem
Pooled
0 50% 100% 0 50% Sustaining100% 0
implementation 50% 100% 0
Sustaining imple
HIC
Services Systems
UMIC
None to minimal implementation None to minimal implementation
LMIC Initiating implementation Initiating implementation
Sustaining implementation Sustaining implementation
LIC
0 20% 40% 60% 80% 100%
FIGURE 12D. FIGURE 12E.

Strengthen governance and accountability systems Enable system-level strengthening
Pooled Pooled
HIC HIC
UMIC UMIC
LMIC LMIC
LIC LIC
0 20% 40% 60% 80% 100% 0 20% 40% 60% 80% 100%
Photo credits:
Yuka Sumi, WHO (left)
Eva Heras, Andorra (right)
More than 40 Member States

have expressed interest and requested
technical support from WHO to
implement ICOPE in the near future
(2022–2023)
43
LEARNING GAINED IN
T H E I CO P E P I LOT R E A DY P H A S E
The ICOPE approach is continuing to generate interest

globally. It is also garnering support across the health and
social care sectors in many Member States, from the level of KEY FINDINGS
national ministries to the subnational and local government
levels. Growing support for ICOPE is further evidenced Three key findings of the ready phase pilot highlight
by the establishment of multisectoral partnerships with opportunities for ICOPE implementation:
community, civil society and professional organizations.
More than 40 Member States have expressed interest and Positive attitudes from health and care
requested technical support from WHO to implement ICOPE workers towards the principles of integrated
in the near future (2022–2023). care and high levels of commitment to the
adoption and implementation of ICOPE. The fact
This momentum has continued despite the challenges that the workforce is engaged with the provision
posed by COVID-19. While the pandemic has affected the of integrated care for older people demonstrates
implementation of pilot studies in some contexts, it has that with appropriate workforce capacity-building
also highlighted the importance of providing integrated and (volume, training) and creating enabling service
person-centred care for older people. ICOPE provides an delivery environments (optimising workflow,
opportunity to respond to the challenges within health and infrastructure, universal health coverage), service
social care systems that have been laid bare by the pandemic, delivery can change (bottom up).
and to ensure more targeted, accessible and quality care for
current and future generations of older people. Proactive engagement of older people and
their communities is crucial across all steps
The scorecard survey for implementation readiness of of the pathway, and in particular step 5. This
health and social care services and systems identified was highlighted in feedback from both older
that implementation readiness varies considerably across participants, and health and care workers.
settings. This finding highlights the need for supportive
actions to be oriented towards the unique needs of ICOPE is feasible to implement in different
individual settings. On average, implementation readiness contexts, as shown by real-world case
is more advanced in service areas than at the systems studies from different countries. They also
levels, and more advanced overall in high-income countries. demonstrate the value of local co-design and
Supporting the system-level adoption of ICOPE, particularly adaptation to suit local context and to optimise
in lower-resourced settings, will be important for global local workforce engagement and training.
scalability.
Specific barriers to for the implementation of ICOPE in different contexts is

needed, taking into account measurement of the goal of the
implementation can be ICOPE approach and the need to appropriately remunerate

and reimburse workers for their time. A financial model
addressed should support ICOPE care pathways to be included within
universal health coverage in each Member State.
As well as highlighting those opportunities, the ready
phase has identified some challenges that will need further DIGITAL TECHNOLOGY
consideration and action in the later phases of the ICOPE
implementation and scale-up. The studies highlighted the use of digital technology as a
potential enabler of ICOPE implementation but pointed to
HUMAN RESOURCES particular challenges that need to be overcome. There is a
need for a range of digital tools for screening, assessment,
A lack of health and care workers was the most commonly and monitoring and analysing data. Experiences from the case
cited barrier to the implementation of ICOPE across studies studies on the necessary adaptations to existing digital tools
and contexts. Insufficient workers across cadres present reinforce the need for further optimization of digital resources
challenges for the delivery of integrated care and the and the importance of a design flexibility that enables local
ability of systems and services to ensure the appropriate adaptation to address issues of access, interoperability,
division of labour to enable implementation of all the steps integrity, data governance, cybersecurity and usability. Beyond
of the pathway. Addressing these barriers will require clinical practice tools to optimize screening and assessment,
a multipronged approach focused on increasing the there is a need to build capacity in electronic health and social
workforce, improving links with informal caregivers, and care data systems and to ensure digital tools are integrated
improving knowledge and skills among existing and new within these systems, to facilitate information sharing and
health and care workers, through enhanced training in coordination in service delivery so that personalized care
the ICOPE approach. It will also be important to leverage plans can be optimally developed and implemented.
clinical practice opportunities with digital tools and to share
training resources to enable a consistent approach across COORDINATION AND COLLABORATION
contexts. There may also be opportunities to manage the
workloads of health and care workers by encouraging self- A lack of coordination and collaboration within and between
screening among older people. For this to be an acceptable health and social care systems was identified as a barrier to
strategy, the effectiveness of a self-screening approach implementation readiness, but improvements in this area
needs to be further assessed through the ICOPE pilot. could also be an outcome of the ICOPE approach, particularly
in the context of the implementation framework (8) for health
FINANCING and social care services and systems (e.g. the themes of
“strengthening governance and accountability” and to
Another key issue relates to financing for integrated care, “enable system-level strengthening”). The degree of existing
particularly to ensure the sustainability and scalability of integration versus fragmentation between health and social
the ICOPE approach. Respondents highlighted the need care systems in Member States needs to be understood to
for a health economics assessment (cost-effectiveness inform priority actions for implementation. The opportunity
analysis) that can inform advocacy for the adoption for participating Member States to more clearly define
and implementation of ICOPE. This will be addressed the different roles and responsibilities of the health and
during the set phase of the ICOPE implementation pilot social care systems and workers to provide ICOPE could
programme. In addition, a sustainable financial model support improved coordination and collaboration. Use of
the scorecard in the implementation framework may help
to identify the areas of prioritized action for national and
subnational systems.
Learning gained in the ICOPE pilot ready phase 45
Informing the next phases The United Nations Decade of Healthy Ageing is an
important opportunity for stakeholders to come together
of ICOPE implementation to deliver its vision for “a world in which all people can live
longer and healthier lives” (5). The ICOPE approach will play
The ICOPE implementation pilot programme has allowed an important role in this effort and WHO will continue to
the identification of barriers and enablers in this ready support Member States to take action to strengthen health
phase, and these will inform subsequent adaptation that and social care systems to implement ICOPE, irrespective
further supports the effective implementation of the ICOPE of their current level of readiness. If achieved, this will
approach. The set phase, through planned and coordinated represent a paradigm shift in the way the world approaches
ICOPE implementation pilots around the world, will build on the health and well-being of older people. By focusing on
this experience and learning. the promotion of intrinsic capacity and the prevention
of declines through the provision of integrated, person-
The teams behind the four case studies in this report centred care, implementing ICOPE will move away from the
have plans to implement the subsequent phases, and traditional medical model of only diagnosing, and managing
some of the work is already ongoing. They all aim to reach diseases and disorders.
significantly greater numbers of older people with the

ICOPE approach. If governments can recognize the value of responding to the
additional resource needs of implementing ICOPE as part
The work undertaken to date has also led to specific of efforts towards universal health coverage, while at the
commitments from other stakeholders. In 2022, the same time harnessing high levels of grassroots support and
Government of China has published a national plan for stakeholder engagement, as outlined in this ready phase
healthy ageing (21), which includes advancing integrated pilot report, then we can expect a brighter future for older
care for older people as a key action area, and has launched people around the world.
an action plan for capacity building in primary care to

improve ability to implement integrated care for the older
population. Andorra’s healthcare service has committed to
establishing a population-wide prevention strategy for older
people focused on functional ability and the Ministry of
Health in France plans to support the scale up of the ICOPE
pilot in five regions, targeting 50,000 older people (over 60
years of age) with three years of follow up (22).
WHO will continue to support

Member States to take action to
strengthen health and social care
systems to implement ICOPE,
irrespective of their current level
of readiness
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care services to meet older people’s needs. Bull World Health Organ. 2017;95(11):756–63. doi:10.2471/BLT.16.187617.
7. Integrated care for older people: guidelines on community-level interventions to manage declines in intrinsic capacity.
Geneva: World Health Organization; 2017 (https://www.who.int/publications/i/item/9789241550109, accessed 17
November 2021).
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Health Organization; 2019 (https://www.who.int/publications/i/item/9789241515993, accessed 7 January 2022).
9. Integrated care for older people (ICOPE): guidance for person-centred assessment and pathways in primary care. Geneva:
World Health Organization; 2019 (https://www.who.int/publications/i/item/WHO-FWC-ALC-19.1, accessed 7 January 2022).
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review of reviews. BMJ Open. 2018;8(4):e021194. doi: 10.1136/bmjopen-2017-021194.
11. Briggs AM, Araujo de Carvalho I. Actions required to implement integrated care for older people in the community using
the World Health Organization’s ICOPE approach: a global Delphi consensus study. PLoS One. 2018;13(10):e0205533.
doi:10.1371/journal.pone.0205533.
12. Clinical Consortium on Healthy Ageing. In: WHO [website]. Geneva: World Health Organization; no date (https://www.who.
int/groups/clinical-consortium-on-healthy-ageing, accessed 23 February 2022).
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behaviour change interventions. Implement Sci. 2011;6:42. doi: 10.1186/1748-5908-6-42.
14. Mathur A, Bhardwaj P, Joshi NK, Jain YK, Singh K. Intrinsic capacity of rural elderly in Thar Desert using WHO ICOPE
(integrated care for older persons) screening tool: a pilot study. medRxiv 2022.02.04.22270231. doi:10.1101/2022.02.04.2
2270231.
15. Departament d’Estadística, Andorra, Population by parish 2020 (www.estadistica.ad/serveiestudis/web/banc_

dades4.asp?formules=inici&any1=01/01/2016&any2=01/01/2020&codi_divisio=2162&codi_tema=2&lang=4&codi_
subtemes=8&ordre_descripcio=1 accessed 28 February 2022).
References 47
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tjgb/8a24fe8379e87d930179ea8cba4b02c0.html, accessed 23 February 2022).
17. Demographics. Occitanie / Pyrénées-Méditerranée Region [website] (https://www.laregion.fr/Demographics, accessed

23 February 2022); Population from 1999 to 2021. Institut National de la Statistique et des Études Économiques; 2021
(https://www.insee.fr/fr/statistiques/2012713#tableau-TCRD_004_tab1_regions2016, accessed 23 February 2022).
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php, accessed 23 February 2022).
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and Training in Geriatrics; no date (http://inspire.chu-toulouse.fr/fr/telechargez-lapplication-icope-monitor, accessed 23
February 2022).
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(http://www.nhc.gov.cn/lljks/pqt/202203/c51403dce9f24f5882abe13962732919.shtml, accessed 8 April 2022).
22. Arrêté du 28 décembre 2021 relatif à l’expérimentation « Programme de prévention de la perte d’autonomie axé sur le
dépistage multidimensionnel du déclin fonctionnel lié à l’âge (ICOPE) ». Légifrance (https://www.legifrance.gouv.fr/jorf/id/
JORFTEXT000044844614?init=true&page=1&query=SSAS2138665A, accessed 7 January 2022).
ANNEX 1:
Micro survey on ICOPE implementation in
clinical and community setting
SURVEY PREPARATION
Review the generic ICOPE care pathway using the ICOPE handbook and app via a narrated
two-minute online tutorial.
ABOUT YOU
Are you providing care to older people, with at least two years of experience?
 Yes  No
 Medical doctor (please specify)  Health assistant

 General/primary care physician  Physiotherapist
 Geriatrician  Occupational therapist
 Specialist doctor  Nutritionist
 Resident  Psychologist
 Nurse  Midwife
 Dentist  Community health worker, including volunteer
 Pharmacist  Social care worker
 Other (please describe):

If no, survey ends:
Thank you so much. This survey is targeting health and social care workers who provide care to
older people, with at least two years of experience.

ABOUT YOUR SETTING
Where do you provide care to older people? (You can select more than one answer)
 General physician’s office/primary care/family  Long-term care facility

medical practice  Mobile clinic
 Community health care centre  Field outreach (e.g. monthly camp)
 Outpatient care in secondary hospital  Home visit
 Inpatient care in secondary hospital  Other (please describe):
 Outpatient care in tertiary hospital
 Inpatient care in tertiary hospital
LOCATION
WHO region:
 African region Country:
 Eastern Mediterranean region _______________________________________________
 European Region  Urban
 Region of the Americas  Rural
 South-East Asia region
 Western Pacific region
Annexes 49
SCENARIO-BASED QUESTIONNAIRE
ICOPE IMPLEMENTATION IN YOUR SETTING
Let’s run through a very simple example of how ICOPE could be implemented in your clinical setting.
In reality, many older persons face multiple complex challenges, and ICOPE has been designed
to be able to guide the clinician through this complex scenario.
Reminder: please respond to all questions based on your experience, situation and context prior to
the COVID 19 pandemic.
STEP 1
Screening for loss of intrinsic capacity in the community

using ICOPE screening tool
Screening could occur in one of two scenarios:
A. In the first, it is done elsewhere outside your practice. For example, your local community
health centre has set up an ICOPE screening site and older people are beginning to be referred
to your clinic for further person-centred assessment and management; or
B. You begin to screen your older people using the ICOPE Screening tool in your practice.
1. W
hat do you think is the most likely way that screening (step 1) and the following ICOPE steps
will work in your context?
 Both screening and further ICOPE pathway steps will be conducted by you or your practice
 Screening and assessment would be conducted by different groups (e.g. screening by community
health workers and additional steps by a primary care practice)

2. If you or your practice will do screening, do you have staff to do this?
 Yes
 No
3. Would you or your staff need additional training for this screening step?
 Yes
 No
4. If you or your practice will do screening, do you have sufficient space to do so?
 Yes
 No
5.
What are key enablers to conducting screening for loss of intrinsic capacity in your clinical setting?
(You can select more than one answer)
 Community engagement, including volunteers

 Support from:  local government
 civil society organizations
 academic associations (e.g. medical associations)
 Local mechanism/system for timely referral
 Local network of multidisciplinary stakeholders
 Training provided by local, national authorities
 Availability of screening tool in local language
 Proactive engagement of older people and their caregivers
 Local and/or global platform to share the experience
 Mobile ICOPE handbook app and data dashboard
 Financial incentives or reimbursement for this activity
 Access to telehealth for this activity
 Other:
6.
Can you foresee any barriers to conducting screening for loss of intrinsic capacity in your
clinical setting?
 Additional time required

 Limited space for conducting the evaluation along with routine activities
 Lack of available staff
 Reimbursement for additional time and staff
 Lack of knowledge and training to conduct screening
 Lack of integration with existing medical record
 Competition, redundancy or conflict with other health services
 Reaching to older people is difficult
 ICOPE screening tool needs to be adapted to local context
 Other:
_________________________________________________________________________________________________________
 No, I do not see any barriers
STEP 2.1
Assessment of intrinsic capacity domains found positive on screening
Let’s imagine a 79-year-old woman has screened positive for possible loss of mobility.
1. Who will make an in-depth assessment of mobility (as per the ICOPE handbook, e.g. the short
physical performance battery, SPPB)? (You can select more than one answer)
 Me
 Other staff in my practice
 Referral to other setting
– If referring to other setting, what is the mechanism from step 1 to step 2?
_________________________________________________________________________________________________________
Annexes 51
2. If you or your practice would do an in-depth assessment on mobility, do you need additional
staff to do this?
 Yes
 No
3. Would you or your staff need additional training for this step?
 Yes
 No
4. Do you have sufficient space to do this assessment at the same time as continuing your
routine activities?
 Yes
 No
5. What are the key enablers to conducting detailed assessment for loss of intrinsic capacity in your
clinical setting? (You can select more than one answer)

 Local mechanism/system is in place for timely referral

 Other:
6.
Can you foresee any barriers to conducting detailed assessment for loss of intrinsic capacity in your
clinical setting? (You can select more than one answer)
 Additional time needed

 Lack of knowledge and training to conduct assessment
 Assessment tool needs to be adapted to local context
 Other:
________________________________________________________________________________________________________
STEP 2.2
Assess and manage – diseases and associated conditions
Following the ICOPE care pathways, the woman is found to have undiagnosed and untreated
osteoarthritis that may be contributing to her loss of mobility. You therefore discuss osteoarthritis
treatment options and develop a management plan, including follow up in six months.
1.
Who will make an assessment and manage diseases and associated conditions as detailed in the
ICOPE handbook (e.g. polypharmacy, pain, frailty)? (You can select more than one answer)
 Me
 Other staff
 Referral to other setting (e.g. a specialist doctor)
If referring, what is the mechanism for disease management?
Please describe:
2.
If you or your practice will do and assessment and manage diseases and associated conditions, will
you need additional staff to do this?
 Yes
 No
3.
Would you or your staff need additional training for this step?
 Yes
 No
4.
Do you have sufficient space to so this at the same time as continuing your routine activities?
 Yes
 No
Annexes 53
5.
What are key enablers for disease assessment and management in your clinical setting?

 Other:
6.
Can you foresee any barriers against disease assessment and management in your clinical setting?

 Other:

STEP 2.3
Assess and manage – social and physical environments, social care and support
Using the ICOPE handbook you also assess her social and physical environment and needs of social
care and support. You find that she lives on the third floor of an apartment building with no lift and so
is homebound for most of the time, gets insufficient exercise, feels lonely and sometimes struggles to
get her shopping.

1. Who will make an assessment and manage the social and physical environment as detailed in the
ICOPE handbook (e.g. home assessment and adaptations to prevent falls; assessment of needs for
assistive devices)?
 Me
 Other staff
 Referral to other setting (e.g. to a social care worker)
If referring, what is the mechanism for assessing and managing social and physical environment?
Please describe:
2. If you or your practice will do the assessment and manage the social and physical environment,
will you need additional staff to do this?
 Yes
 No
 Yes
 No
4. Do you have sufficient space and administrative support to so this at the same time as continuing
your routine activities?
 Yes
 No
5.
What are key enablers in your clinical setting for the assessment and management of the social and
physical environment? (You can select more than one answer)

 Other:
______________________________________________________________________________________________
Annexes 55
6.
Can you foresee any barriers in your clinical setting against the assessment and management of the
social and physical environment ? (You can select more than one answer)

 Lack of infrastructure and system to provide integrated health and social care
 Assessment tool needs to be adapted to local context
 Competition, redundancy or conflict with other health and social services
 Other: __________________________________________________________________________________________
STEP 3
Personalized care plan
The ICOPE handbook app will assist you with creating a person-centred and integrated care plan
for this woman. This includes setting a goal, the management for declines in intrinsic capacity
and treatable medical conditions, and the plan for dealing with issues in the social and physical
environment. Creating such a plan takes a little time and needs to be thought through carefully in
consultation with the older person (and caregivers).
In this woman’s example, you agree a multimodal exercise programme, first assessing the safety of
starting one.
1.
Who will develop a care plan together with the older person?
 Me
 Other staff
 Referral to other setting (e.g. to a social care worker)
If referring, what is the mechanism for developing a personalized care plan?
Please describe:
2.
If you or your practice will create the care plan, do you need additional staff to do this?
 Yes
 No
3.
Would you or your staff need additional training for this step?
 Yes
 No
4.
Do you have sufficient space to do this at the same time as continuing your routine activities?
 Yes
 No
5.
What are key enablers for developing a personalized care plan in your clinical setting?
 Community engagement, including vwolunteers

 Local network of multidisciplinary stakeholders (e.g. physiotherapist, occupational therapist)
 Other:
6.
Can you foresee any barriers to developing a personalized care plan in your clinical setting?

 Lack of infrastructure and system to provide integrated health and social care
 Lack of knowledge and training to develop a care plan
 Other:
_________________________________________________________________________________________________________
Annexes 57
STEP 4
Ensure referral pathway and monitoring of care plan
At the six-month review, the woman’s osteoarthritis has not improved and she is suffering with pain.
She therefore needs referral to a specialist.
1. Who will do this follow up and organize referral? (You can select more than one answer)
 Me
 Other clinic staff
 Referral to other setting
If referring, what is the mechanism for monitoring and referral?
Please describe:
2. If you or your practice will organize this, will you need additional staff to do so?
 Yes
 No
 Yes
 No
4. Do you have administrative support to do this at the same time as continuing your routine activities?
 Yes
 No
5. What are key enablers for follow-up and referral in your clinical setting?

 Other:
6
Can you foresee any barriers to follow up and referral in your clinical setting?

 No common digital information platform (e.g. medical record, health record,
social care needs)
 Other:
STEP 5
Engage communities and support caregivers
At her initial social assessment the woman was found to be lonely. You therefore referred her to local
civil society organization that has arranged regular home visits. Through this she has started a weekly
outing with other members of the local community and is reporting feeling much better about herself
and more confident about her mobility.
1.
Do you have a contact with local government, a local civil society organization or a volunteer group to
provide support for your older people?
 Yes
 No
2.
Who will carry out this kind of community engagement? (You can select more than one answer)
 Me
 Other staff
 Referral to others
If referring, what is the mechanism for referral to the community activities?
Please describe:
3.
If you or your staff will organize this, do you need additional staff to do so?
 Yes
 No
Annexes 59
4.
What are the key enablers in your clinical setting for community engagement?

 Other:
5.
Can you foresee any barriers to community engagement in your clinical setting?

 No information on community activities
 Other:

ANNEX 2:
Respondents to micro survey
This annex gives fuller information to supplement the summary data presented in the main part of this report
(Table 2 and Figure 6).
TABLE A2.1.
Distribution of respondents by regions and country income levels
WHO region Country Income level N %

Cabo Verde Lower middle 5 1.9
Kenya Lower middle 2 0.8
African region Senegal Lower middle 3 1.2
South Africa Upper middle 4 1.5
Zimbabwe Lower middle 3 1.2
subtotal 17 6.6
Argentina Upper middle 9 3.5
Brazil Upper middle 1 0.4
Region of the Americas Chile High 36 13.8
Cuba Upper middle 4 1.5
Mexico Upper middle 2 0.8
subtotal 52 20.0
Bahrain High 1 0.4
Egypt Lower middle 1 0.4
Eastern Mediterranean region Oman High 1 0.4
Pakistan Lower middle 1 0.4
Qatar High 1 0.4
subtotal 5 2.0
Andorra High 4 1.5
France High 6 2.3
Italy High 43 16.5
European region Portugal High 22 8.5
Russian Federation Upper middle 3 1.2
Spain High 19 7.3
United Kingdom High 7 2.7
subtotal 104 40.0

Bhutan Lower middle 2 0.8
India Lower middle 1 0.4
South-East Asia region
Indonesia Upper middle 4 1.5
Nepal Lower middle 11 4.2
subtotal 18 6.9
China Upper middle 34 13.1
Western Pacific region Republic of Korea High 9 3.5
Viet Nam Lower middle 21 8.1
subtotal 64 24.7
grand total 260
Annexes 61
FIGURE A2.1.
Distribution of respondents by setting
Other
17.3%
Community*
15.8%
General practice†
Home visit 14.2%
10.4%
Long term care facility
10.8%
Hospital‡
15.0%
Tertiary§
16.5%
* With health-care centres making up 14.2% of the whole pie, field outreach (e.g. camp) 1.2% and mobile clinics 0.4%
† General physician/primary care/family medicine practice
‡ Secondary care, with inpatient care representing 11.2% of the whole pie and outpatient 3.8%
§ With inpatient tertiary care making up 9.6% of the whole pie and outpatient 6.9%
ANNEX 3:
Respondents to service- and system-level survey
using scorecard
This annex gives fuller information to supplement the summary data presented in the main part of this report (Figure 8).
TABLE A3.1.
Distribution of respondents by regions and country income levels
WHO region Country Income level N %

Cabo Verde Lower middle 9 3.5
Gabon Upper middle 7 2.7
Kenya Lower middle 5 1.9
African region Mozambique Low 7 2.7
Senegal Lower middle 4 1.5
South Africa Upper middle 2 0.8
Zimbabwe Lower middle 5 1.9
subtotal 39 15.0
Argentina Upper middle 18 6.9
Brazil Upper middle 5 1.9
Chile High 31 12.0
Region of the Americas
Costa Rica Upper middle 3 1.2
Cuba Upper middle 3 1.2
Mexico Upper middle 5 1.9
subtotal 65 25.1
Bahrain High 2 0.8
Jordan Upper middle 4 1.5
Kuwait High 1 0.4
Lebanon Upper middle 1 0.4
Eastern Mediterranean region Morocco Lower middle 1 0.4
Oman High 2 0.8
Pakistan Lower middle 3 1.2
Saudi Arabia High 1 0.4
Tunisia Lower middle 1 0.4
subtotal 16 6.3
Andorra High 4 1.5
France High 1 0.4
Italy High 12 4.6
European region Portugal High 45 17.4
Russian Federation Upper middle 2 0.8
Spain High 4 1.5
United Kingdom High 19 7.3
subtotal 87 33.5
Bhutan Lower middle 1 0.4
India Lower middle 6 2.3
Indonesia Upper middle 7 2.7
Nepal Lower middle 5 1.9
subtotal 19 7.3
China Upper middle 16 6.2
Western Pacific region
Viet Nam Lower middle 17 6.6
subtotal 33 12.8
grand total 259
Annexes 63
ANNEX 4:
Capacities, enablers and barriers for ICOPE adoption
in clinical settings, by income levels and regions
This annex gives fuller information to supplement the summary data presented in the main part of this report (Tables 2 and 3).
TABLE A4.1.
High-income countries (N=149)
STEPS 1 2.1 2.2 2.3 3 4 5
ICOPE In-depth IC Assessment Assessment Develop care Follow-up Community

screening assessment and and plan and referral engagement
(e.g. limited management management
mobility) of diseases of social
and physical
environment
n % n % n % n % n % n % n %
Local requirements to implement ICOPE

Need staff 49 32.90 93 62.42 104 69.80 103 69.13 106 71.14 89 59.73 110 73.83
Need training 104 69.80 101 67.79 99 66.40 97 65.10 104 69.80 88 59.06 NA
Need space 79 34.20 69 46.31 61 40.90 76 51.01 68 45.64 NA NA
Need administrative
NA NA NA NA NA 83 55.70 NA
support
Enablers to ICOPE steps

Support from local
47 31.54 42 28.19 34 22.82 53 35.57 52 34.90 30 20.13 91 61.07
government
Support from civil society
41 27.52 33 22.15 27 18.12 49 32.89 49 32.89 25 16.78 82 55.03
organizations
Support from academic
associations such as 43 28.86 35 23.49 39 26.17 50 33.56 43 28.86 43 28.86 48 32.21
Local mechanism/system is
40 26.85 32 21.48 37 24.83 45 30.20 43 28.86 48 32.21 52 34.90
in place for timely referral
Local network among
multidisciplinary 82 55.03 80 53.69 46 30.87 78 52.35 83 55.70 72 48.32 88 59.06
stakeholders
Training provided by local,
54 36.24 102 68.46 44 29.53 55 36.91 53 35.57 43 28.86 NA
national authorities
Availability of ICOPE
screening/assessment tool 69 46.31 65 43.62 NA NA NA NA NA
in local language
Proactive engagement
of older people and their 105 70.47 85 57.05 78 52.35 86 57.72 97 65.10 71 47.65 93 62.42
caregivers
Local and/or global
platform to share the 49 32.89 45 30.20 48 32.21 50 33.56 46 30.87 45 30.20 55 36.91
experience
Mobile ICOPE handbook
54 36.24 65 43.62 62 41.61 49 32.89 52 34.90 44 29.53 NA
app and data dashboard
Financial incentives or
reimbursement for this 57 38.26 45 30.20 37 24.83 41 27.52 42 28.19 33 22.15 38 25.50
activity
Access to telehealth for this
45 30.20 34 22.82 45 30.20 35 23.49 45 30.20 43 28.86 23 15.44
activity
Access to essential
NA 22 14.77 41 27.52 34 22.82 27 18.12 30 20.13 NA
medicines
Access to assistive
NA 36 24.16 38 25.50 23 15.44 40 26.85 37 24.83 NA
technology
Annexes 65
STEPS 1 2.1 2.2 2.3 3 4 5

and physical
environment
n % n % n % n % n % n % n %
Barriers to ICOPE steps

Additional time required 105 70.47 107 71.81 107 71.81 102 68.46 107 71.81 97 65.10 105 70.47
Limited space for
conducting the evaluation
50 33.56 62 41.61 47 31.54 NA NA NA NA
along with routine
activities
Lack of available staff 86 57.72 83 55.70 87 58.39 82 55.03 90 60.40 80 53.69 93 62.42
Reimbursement for
53 35.57 52 34.90 51 34.23 59 39.60 54 36.24 45 30.20 49 32.89
additional time and staff
Lack of knowledge and
training to conduct this 66 44.30 56 37.58 58 38.93 48 32.21 46 30.87 NA NA
activity
Lack of integration
in digital information
platform (medical record, 46 30.87 42 28.19 43 28.86 43 28.86 48 32.21 59 39.60 NA
health record, social care
needs)
Competition, redundancy
or conflict with other 23 15.44 24 16.11 22 14.77 20 13.42 26 17.45 22 14.77 20 13.42
health services
Reaching to older people is
21 14.09 NA NA NA NA NA NA
difficult
Screening/assessment tool
needs to be adapted to 43 28.86 32 21.48 NA 39 26.17 NA NA NA
local context
Lack of infrastructure
and system to provide
NA NA NA 65 43.62 71 47.65 NA NA
integrated health and
social care
No information on
NA NA NA NA NA NA 45 30.20
community activities
No, I do not see any
5 3.36 6 4.03 8 5.37 9 6.04 9 6.04 22 14.77 8 5.37
barriers
TABLE A4.2.
Upper-middle-income countries (N=61)
STEPS 1 2.1 2.2 2.3 3 4 5

and physical
environment
n % n % n % n % n % n % n %

Need staff 37 60.70 35 57.38 37 60.70 44 72.13 37 60.66 33 54.10 47 77.05
Need training 47 77.00 41 67.21 42 68.90 41 67.21 47 77.05 42 68.85 NA
Need space 10 16.40 11 18.03 12 19.70 19 31.15 8 13.11 NA NA
Need administrative
support

Support from local
31 50.82 25 40.98 18 29.51 28 45.90 25 40.98 21 34.43 38 62.30
government
17 27.87 12 19.67 13 21.31 20 32.79 20 32.79 20 32.79 33 54.10
organizations
21 34.43 20 32.79 26 42.62 22 36.07 22 36.07 32 52.46 26 42.62
Local network among
stakeholders
Trainng provided by local,
30 49.18 41 67.21 25 40.98 23 37.70 23 37.70 21 34.43 NA
in local language
caregivers
Local and/or global
experience
28 45.90 27 44.26 24 39.34 18 29.51 21 34.43 17 27.87 NA
activity
24 39.34 20 32.79 20 32.79 14 22.95 19 31.15 21 34.43 15 24.59
activity
Acces to essential
NA 11 18.03 17 27.87 9 14.75 15 24.59 12 19.67 NA
medicines
Access to assistive
NA 21 34.43 24 39.34 15 24.59 18 29.51 11 18.03 NA
technology
Annexes 67
STEPS 1 2.1 2.2 2.3 3 4 5

and physical
environment
n % n % n % n % n % n % n %

Limited space for
18 29.51 18 29.51 17 27.87 NA NA NA NA
along with routine
activities
Reimbursement for
20 32.79 18 29.51 18 29.51 22 36.07 23 37.70 25 40.98 30 49.18
activity
Lack of integration
platform (medical record, 24 39.34 23 37.70 26 42.62 26 42.62 27 44.26 30.5 50.00 NA
needs)
or conflict with other 5 8.20 7 11.48 7 11.48 6 9.84 8 13.11 23.18 38.00 7 11.48
health services
difficult
local context
NA NA NA 31 50.82 32 52.46 NA NA
social care
No information on
8 13.11 9 14.75 13 21.31 7 11.48 9 14.75 12 19.67 13 21.31
barriers
TABLE A4.3.
Lower-middle-income countries (N=50)
STEPS 1 2.1 2.2 2.3 3 4 5

and physical
environment
n % n % n % n % n % n % n %

Need staff 16 32.00 42 84.00 42 84.00 47 94.00 43 86.00 36 72.00 46 92.00
Need training 43 86.00 41 82.00 42 84.00 45 90.00 43 86.00 37 74.00 NA
Need space 18 36.00 23 46.00 22 44.00 28 56.00 26 52.00 NA NA
Need administrative
support

Support from local
29 58.00 25 50.00 27 54.00 35 70.00 32 64.00 27 54.00 40 80.00
government
23 46.00 20 40.00 19 38.00 23 46.00 23 46.00 23 46.00 31 62.00
organizations
22 44.00 20 40.00 25 50.00 23 46.00 24 48.00 24 48.00 24 48.00
Local network among
stakeholders
29 58.00 22 44.00 24 48.00 26 52.00 27 54.00 23 46.00 NA
in local language
caregivers
Local and/or global
experience
29 58.00 28 56.00 28 56.00 22 44.00 25 50.00 18 36.00 NA
activity
17 34.00 13 26.00 17 34.00 11 22.00 10 20.00 12 24.00 14 28.00
activity
Acces to essential
NA 17 34.00 18 36.00 18 36.00 17 34.00 14 28.00 NA
medicines
Access to assistive
NA 18 36.00 17 34.00 19 38.00 20 40.00 13 26.00 NA
technology
Annexes 69
STEPS 1 2.1 2.2 2.3 3 4 5

and physical
environment
n % n % n % n % n % n % n %

Limited space for
20 40.00 23 46.00 28 56.00 NA NA NA NA
along with routine
activities
Reimbursement for
23 46.00 22 44.00 22 44.00 25 50.00 24 48.00 19 38.00 25 50.00
activity
Lack of integration
needs)
health services
difficult
local context
NA NA NA 28 56.00 31 62.00 NA NA
social care
No information on
3 6.00 6 12.00 7 14.00 5 10.00 6 12.00 10 20.00 6 12.00
barriers
TABLE A4.4.
African region (N=17)
STEPS 1 2.1 2.2 2.3 3 4 5

and physical
environment
n % n % n % n % n % n % n %

Need staff 6 35.30 14 82.35 10 58.80 15 88.24 13 76.47 6 35.29 14 82.35
Need training 14 82.40 14 82.35 11 64.70 13 76.47 14 82.35 8 47.06 NA
Need space 2 11.80 4 23.53 5 29.40 7 41.18 6 35.29 NA NA
Need administrative
support

Support from local
4 23.53 3 17.65 4 23.53 9 52.94 8 47.06 6 35.29 10 58.82
government
6 35.29 3 17.65 3 17.65 7 41.18 5 29.41 5 29.41 10 58.82
organizations
6 35.29 6 35.29 5 29.41 6 35.29 4 23.53 8 47.06 7 41.18
Local network among
stakeholders
13 76.47 6 35.29 10 58.82 8 47.06 8 47.06 8 47.06 NA
in local language
caregivers
Local and/or global
experience
6 35.29 6 35.29 7 41.18 5 29.41 8 47.06 5 29.41 NA
activity
7 41.18 5 29.41 5 29.41 5 29.41 5 29.41 4 23.53 2 11.76
activity
Acces to essential
NA 4 23.53 5 29.41 4 23.53 7 41.18 2 11.76 NA
medicines
Access to assistive
NA 4 23.53 5 29.41 7 41.18 7 41.18 2 11.76 NA
technology
Annexes 71
STEPS 1 2.1 2.2 2.3 3 4 5

and physical
environment
n % n % n % n % n % n % n %

Limited space for
3 17.65 5 29.41 5 29.41 NA NA NA NA
along with routine
activities
Reimbursement for
6 35.29 5 29.41 2 11.76 1 5.88% 3 17.65 1 5.88 6 35.29
activity
Lack of integration
platform (medical record, 8 47.06 11 64.71 9 52.94 5 29.41 5 29.41 8.5 50.00 NA
needs)
or conflict with other 2 11.76 3 17.65 3 17.65 2 11.76 2 11.76 6.46 38.00 2 11.76
health services
difficult
local context
NA NA NA 7 41.18 8 47.06 NA NA
social care
No information on
2 11.76 5 29.41 6 35.29 4 23.53 5 29.41 6 35.29 4 23.53
barriers
TABLE A4.5.
Region of the Americas (N=52)
STEPS 1 2.1 2.2 2.3 3 4 5

and physical
environment
n % n % n % n % n % n % n %

Need staff 24 46.15 25 48.00 40 76.90 31 60.00 31 60.00 32 62.00 34 65.00
Need training 36 69.20 33 63.00 41 78.80 31 60.00 36 69.23 32 62.00 NA
Need space 32 38.50 26 50.00 26 50.00 26 50.00 22 42.00 NA NA
Need administrative
support

Support from local
22 42.30 16 31.00 17 33.00 24 46.00 23 44.00 15 29.00 29 56.00
government
14 26.90 12 23.00 10 19.00 18 35.00 16 31.00 12 23.00 24 46.00
organizations
11 21.20 12 23.00 13 25.00 17 33.00 14 27.00 23 44.00 16 31.00
Local network among
stakeholders
14 26.90 45 87.00 13 25.00 15 29.00 13 25.00 14 27.00 NA
in local language
caregivers
Local and/or global
experience
22 42.30 22 42.00 21 40.00 15 29.00 22 42.00 18 35.00 NA
activity
13 25.00 10 19.00 13 25.00 9 17.00 13 25.00 11 21.00 6 12.00
activity
Acces to essential
NA 10 19.00 21 40.00 15 29.00 17 33.00 14 27.00 NA
medicines
Access to assistive
NA 16 31.00 17 33.00 8 15.00 16 31.00 14 27.00 NA
technology
Annexes 73
STEPS 1 2.1 2.2 2.3 3 4 5

and physical
environment
n % n % n % n % n % n % n %

Limited space for
17 32.69 25 48.08 20 38.46 NA NA NA NA
along with routine
activities
Reimbursement for
15 28.85 14 26.92 15 28.85 14 26.92 12 23.08 15 28.85 16 30.77
activity
Lack of integration
needs)
health services
difficult
local context
NA NA NA 42 40.38 25 48.08 NA NA
social care
No information on
3 5.77 4 7.69 6 11.54 8 7.69 4 7.69 9 17.31 8 15.38
barriers
TABLE A4.6.
Eastern Mediterranean region (N=5)
STEPS 1 2.1 2.2 2.3 3 4 5

and physical
environment
n % n % n % n % n % n % n %

Need staff 3 60.00 5 100.00 4 80.00 5 100.00 3 60.00 2 40.00 4 80.00
Need training 4 80.00 5 100.00 3 60.00 4 80.00 3 60.00 3 60.00 NA
Need space 2 40.00 4 80.00 1 20.00 3 60.00 3 60.00 NA NA
Need administrative
support

Support from local
1 20.00 5 100.00 1 20.00 5 100.00 5 100.00 5 100.00 3 60.00
government
1 20.00 1 20.00 1 20.00 1 20.00 5 100.00 5 100.00 1 20.00
organizations
1 20.00 1 20.00 1 20.00 1 20.00 1 20.00 1 20.00 1 20.00
Local network among
stakeholders
3 60.00 2 40.00 3 60.00 4 80.00 4 80.00 3 60.00 NA
in local language
caregivers
Local and/or global
experience
5 100.00 2 40.00 3 60.00 2 40.00 1 20.00 2 40.00 NA
activity
2 40.00 3 60.00 3 60.00 2 40.00 2 40.00 3 60.00 2 40.00
activity
Acces to essential
NA 5 100.00 5 100.00 5 100.00 5 100.00 5 100.00 NA
medicines
Access to assistive
NA 5 100.00 5 100.00 5 100.00 5 100.00 5 100.00 NA
technology
Annexes 75
STEPS 1 2.1 2.2 2.3 3 4 5

and physical
environment
n % n % n % n % n % n % n %

Limited space for
3 60.00 2 40.00 1 20.00 NA NA NA NA
along with routine
activities
Reimbursement for
1 20.00 1 20.00 1 20.00 2 40.00 2 40.00 1 20.00 1 20.00
activity
Lack of integration
needs)
health services
difficult
local context
NA NA NA 2 40.00 1 20.00 NA NA
social care
No information on
0 0 0 0 1 20.00 0 0 1 20.00 1 20.00 1 20.00
barriers
TABLE A4.7.
European region (N=105)
STEPS 1 2.1 2.2 2.3 3 4 5

and physical
environment
n % n % n % n % n % n % n %

Need staff 30 28.80 69 66.35 68 65.40 73 70.19 80 76.92 59 56.73 82 78.85
Need training 71 68.30 67 64.42 65 62.50 68 65.38 72 69.23 57 54.81 NA
Need space 32 30.80 40 38.46 37 35.60 53 50.96 45 43.27 NA NA
Need administrative
support

Support from local
32 30.77 31 29.81 21 20.19 39 37.50 37 35.58 17 16.35 69 66.35
government
28 26.92 24 23.08 19 18.27 35 33.65 37 35.58 15 14.42 64 61.54
organizations
33 31.73 26 25.00 29 27.88 31 29.81 34 32.69 33 31.73 38 36.54
Local network among
stakeholders
44 42.31 64 61.54 35 33.65 42 40.38 41 39.42 29 27.88 NA
in local language
caregivers
Local and/or global
experience
40 38.46 45 43.27 41 39.42 33 31.73 30 28.85 25 24.04 NA
activity
39 37.50 27 25.96 36 34.62 28 26.92 34 32.69 32 30.77 19 18.27
activity
Acces to essential
NA 14 13.46 28 26.92 24 23.08 16 15.38 19 18.27 NA
medicines
Access to assistive
NA 26 25.00 28 26.92 17 16.35 29 27.88 26 25.00 NA
technology
Annexes 77
STEPS 1 2.1 2.2 2.3 3 4 5

and physical
environment
n % n % n % n % n % n % n %

Limited space for
34 32.69 36 34.62 30 28.85 NA NA NA NA
along with routine
activities
Reimbursement for
36 34.62 38 36.54 36 34.62 45 43.27 42 40.38 31 29.81 36 34.62
activity
Lack of integration
needs)
health services
difficult
local context
NA NA NA 43 41.35 47 45.19 NA NA
social care
No information on
5 4.81 4 3.85 6 5.77 7 6.73 7 6.73 17 16.35 7 6.73
barriers
TABLE A4.8.
South-East Asia region (N=18)
STEPS 1 2.1 2.2 2.3 3 4 5

and physical
environment
n % n % n % n % n % n % n %

Need staff 7 38.90 14 78.00 15 83.30 17 94.00 14 78.00 11 61.00 16 89.00
Need training 17 94.40 15 83.00 15 83.30 16 89.00 14 78.00 11 61.00 NA
Need space 11 61.10 12 67.00 10 55.60 13 72.00 10 56.00 NA NA
Need administrative
support

Support from local
11 61.10 7 39.00 9 50.00 13 72.00 9 50.00 10 56.00 14 78.00
government
8 44.40 6 33.00 6 33.00 9 50.00 9 50.00 8 44.00 13 72.00
organizations
8 44.40 7 39.00 11 61.00 10 56.00 10 56.00 12 67.00 11 61.00
Local network among
stakeholders
13 72.20 9 50.00 10 56.00 12 67.00 12 67.00 9 50.00 NA
in local language
caregivers
Local and/or global
experience
8 44.40 11 61.00 11 61.00 8 44.00 8 44.00 7 39.00 NA
activity
7 38.90 6 33.00 8 44.00 8 44.00 7 39.00 9 50.00 9 50.00
activity
Access to essential
NA 9 50.00 9 50.00 11 61.00 7 39.00 9 50.00 NA
medicines
Access to assistive
NA 8 44.00 7 39.00 7 39.00 8 44.00 7 39.00 NA
technology
Annexes 79
STEPS 1 2.1 2.2 2.3 3 4 5

and physical
environment
n % n % n % n % n % n % n %

Limited space for
11 61.11 13 72.22 14 77.78 NA NA NA NA
along with routine
activities
Reimbursement for
7 38.89 8 44.44 6 33.33 11 61.11 11 61.11 12 66.67 9 50.00
activity
Lack of integration
needs)
health services
difficult
local context
NA NA NA 13 72.22 11 61.11 NA NA
social care
No information on
0 0 0 0 1 5.56 0 0 0 0 2 11.11 0 0
barriers
TABLE A4.9.
Western Pacific region (N=64)
STEPS 1 2.1 2.2 2.3 3 4 5

and physical
environment
n % n % n % n % n % n % n %

Need staff 19 29.70 43 67.00 46 71.90 53 83.00 45 70.00 48 75.00 53 83.00
Need training 52 81.30 49 77.00 48 75.00 51 80.00 55 86.00 56 88.00 NA
Need space 12 18.80 17 27.00 16 25.00 21 33.00 16 25.00 NA NA
Need administrative
support

Support from local
37 57.80 35 55.00 8 42.00 31 48.00 32 50.00 30 47.00 44 69.00
government
24 37.50 19 30.00 6 31.00 22 34.00 25 39.00 28 44.00 34 53.00
organizations
24 37.50 20 31.00 8 45.00 25 39.00 26 41.00 27 42.00 29 45.00
Local network among
stakeholders
26 40.60 39 61.00 6 34.00 23 36.00 25 39.00 24 38.00 NA
in local language
caregivers
Local and/or global
experience
35 54.70 34 53.00 9 48.00 26 41.00 29 45.00 22 34.00 NA
activity
18 28.10 16 25.00 5 27.00 8 13.00 13 20.00 17 27.00 14 22.00
activity
Access to essential
NA 13 20.00 4 20.00 7 11.00 12 19.00 12 19.00 NA
medicines
Access to assistive
NA 21 33.00 6 34.00 18 28.00 18 28.00 12 19.00 NA
technology
Annexes 81
STEPS 1 2.1 2.2 2.3 3 4 5

and physical
environment
n % n % n % n % n % n % n %

Limited space for
20 31.25 22 34.38 6 34.38 NA NA NA NA
along with routine
activities
Reimbursement for
31 48.44 26 40.63 9 48.44 33 51.56 31 48.44 29 45.31 36 56.25
activity
Lack of integration
needs)
health services
difficult
local context
NA NA NA 38 59.38 42 65.63 NA NA
social care
No information on
6 9.38 8 12.50 2 12.50 6 9.38 7 10.94 9 14.06 7 10.94
barriers
ANNEX 5:
Attitudes towards implementation of ICOPE and
changes to clinical practice
This annex gives fuller information to supplement the summary data presented in the main part of this report (Table 4).
FIGURE A5.1.
Implementation attitudes (15 items) by country income levels
Total income High income Upper middle income Lower

N=260 N=149 N=61
ICOPE approach is important
Need for change of current practice
The environmental assessment is not my responsibility
Management of disease is standard practice
Implementing ICOPE requires more time
ICOPE will facilitate the engagement of older people
Need for reimbursement for ICOPE approach
Need for policy and system level leadership
Need for better referral pathways
Need for online training in local language on ICOPE
Need for integration into medical record system
Need for digital tools
Need for health expert support
Need for support from CSOs
Need for dissemination and communication of ICOPE
0 50% 100% 0 50% 100% 0 50% 100% 0
Agree Neutral Disagree
Total income High income Total

Upper income
middle income LowerHigh
middle income
income Upper middle income Lower
N=260 N=149 N=260
N=61
Total income HighN=50
N=149
income N=61 income
Upper middle Lower
N=260 N=149 N=61
ICOPE
Need for approach
change is important
of current practice
The environmental assessment
Management is not
of disease my responsibility
is standard practice
Management
Implementingof disease
ICOPE is standard
requires practice
more time
ICOPE Need
will facilitate the engagement
for reimbursement of older
for ICOPE people
approach
Need
Needfor reimbursement
for for ICOPE
policy and system approach
level leadership
Need for
Need for online training in better referral pathways
local language on ICOPE
Need for online training in local language
Need for integration into medical record onsystem
ICOPE
Need for
Need for health digital
expert tools
support
Need
Need for dissemination and for support from
communication CSOs
of ICOPE
50% 100% 0 50% 100% 00 50%
50% 100% 00 50%
50% 100% 0
100% 50% 100% 0
0 50% 100% 0 50% 100% 0 50% 100% 0
Agree Neutral Disagree Agree Neutral Disagree
Annexes 83
FIGURE A5.2.
Implementation attitudes (15 items) by WHO region
African region Eastern Mediterranean region European region

N=17 N=5 N=104
0 50% 100% 0 50% 100% 0 50% 100%
Region of the Americas South-East Asia region Western pacific region

N=52 N=18 N=64

0 50% 100% 0 50% 100% 0 50% 100%

ANNEX 6:
Implementation readiness by WHO region
This annex gives fuller information to supplement the summary data presented in the main part of this report
(Figures 11 and 12).
FIGURE A6.1.
Overall services and systems implementation readiness
Total implementation readiness score (0-52)
Pooled
AFRO
PAHO
EMRO
EURO
SEARO
WPRO
0 5 10 15 20 25 30 35 40 45 50 55
Median score in WHO regions
Service and system implementation readiness score (0-26)
Pooled Services
Systems
AFRO
PAHO
EMRO
EURO
SEARO
WPRO
0 5 10 15 20 25 30
Annexes 85
FIGURE A6.2. By country income levels (%)

Implementation readiness for three service-level themes and
Total two
income High income
N=259 N=122
system-level themes
1
2
Engage and empower people
By country and
income communities
levels (%) 3 Support the coordination of services delivered
4 by multidisciplinary providers
Total income 5High income Upper middle income Lower mid
N=259 N=122 N=73 N=
6
Pooled Pooled
1 7
AFRO 2 AFRO
8
3 9
PAHO PAHO
4 10
EMRO 5 11
EMRO
6 12
EURO 7 EURO
13
SEARO 8 14
SEARO
9 15
WPRO 10 WPRO
16
11 17 0 20% 40% 60% 80% 100%
0 20% 40% 60% 80% 100%
12 18
13 19
14
15
community-based care 0 50% 100% 0 50% 100% 0
16
17 Services Systems
Pooled 18 None to minimal implementation None to minimal im
AFRO 19 Initiating implementation Initiating implement
0 50% 100% 0 50% Sustaining100% 0
implementation 50% 100% 0
Sustaining 50
impleme
PAHO
EMRO Services Systems

EURO None to minimal implementation None to minimal implementation
SEARO Initiating implementation Initiating implementation

WPRO
0 20% 40% 60% 80% 100%
Strengthen governance and accountability Enable system-level strengthening

systems
Pooled Pooled
AFRO AFRO
PAHO PAHO
EMRO EMRO
EURO EURO
SEARO SEARO
WPRO WPRO
0 20% 40% 60% 80% 100% 0 20% 40% 60% 80% 100%
ANNEX 7:
Implementation readiness by specific actions
This annex gives fuller information to supplement the summary data presented in the main part of this report (Figure 12).
FIGURE A7.1.
Implementation readiness under specific service and system actions
by country income levels
By country income levels (%)
Total income High income Upper middle income Lower middle income
N=259 N=122 N=73 N=57
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
By country income
By country levels
0 income (%) (%)
levels
50% 100% 0 50% 100% 0 50% 100% 0 50% 100%
er middle income Total
Lower income
middle
Total income
income HighLow
income
High income
income Upper middle
Upper income
middle income Lower middle
Lower income
middle income
N=73 ServicesN=259N=57
N=259 N=122N=7
N=122
Systems N=73N=73 N=57N=57
1 1 None to minimal implementation None to minimal implementation
2 2 Initiating implementation Initiating implementation
3 3
4 Sustaining implementation Sustaining implementation
4
5 5
6 6
7 7
8 8
9 9
10 10
11 11
12 12
13 13
14 14
15 15
16 16
17 17
18 18
19 19
50% 0
100% 00 50% 50% 0 00
100%100% 50% 50%
50% 100%100%
0
100% 0 50% 50% 100%100%
0 0 50% 50% 100%100%
0
Services
Services Systems
Systems
ntation NoneNoneto minimal implementation
to minimal implementation NoneNoneto minimal implementation
to minimal implementation
Initiating implementation
Initiating implementation Initiating implementation
n Sustaining implementation
Sustaining implementation
Annexes 87
FIGURE A7.2.
Implementation readiness under specific service and system actions
by WHO regions
By WHO regions
African region Eastern Mediterranean region European region Region of the Americas
N=39 N=16 N=87 N=65
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
By country income
0 levels
50% (%)
Imentation
100% 0
readiness100%
50%
under specific service and
0 50% 100% 0 50% 100%
By country income levels (%) system actions – by WHO regions
Total income High income Upper middle income Lower middle income
ean region Region N=259
of theincome
Total Americas N=122
High income N=73
Western
Upper Pacific
middle region
income N=57
Lower middle income
N=87 N=65
N=259 N=19
N=122 N=33
N=73 N=57
1
2 1
3 2
4 3
5 4
6 5
7 6
8 7
9 8
10 9
11 10
12 11
13 12
14 13
15 14
16 15
17 16
18 17
19 18
190 50% 100% 0 50% 100% 0 50% 100% 0 50% 100% 0
50% 100% 00 50%
50% 100%
100% 00 50%
50% 100% 00
100% 50%
50% 100% 0
100% 50% 100% 0
Services Systems
Services
None to minimal implementation Systems
None to minimal implementation
None to
Initiating minimal implementation
implementation None to
Initiating minimal implementation
implementation
Sustaining implementation Initiating implementation
Sustaining implementation

Integrated Care For Older People (ICOPE) Implementation Pilot Programme

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INTEGRATED CARE FOR OLDER PEOPLE

Integrated care for older people (ICOPE)

findings from the

Integrated care for older people (ICOPE)

findings from the

ISBN 978-92-4-004835-5 (electronic version)

© World Health Organization 2022

Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris.

Design and layout by Erica Lefstad

The ICOPE approach and its implementation 5

DESIGN OF THE THREE-STEP ICOPE

Ready-phase methods to assess ICOPE implementation readiness 10

FINDINGS FROM THE READY PHASE 15

Survey results on readiness at level of service delivery and clinical care 15

LEARNING GAINED IN THE ICOPE PILOT READY PHASE 43

Informing the next phases of ICOPE implementation 45

Annex 1: Micro survey on ICOPE implementation in clinical and community setting 48

The studies suggested a good

KEY OPPORTUNITIES FOR ICOPE

1 Positive attitudes from health and care workers towards

2 Proactive engagement of older people and their

3 ICOPE is feasible to implement in different contexts, as

The findings in this report can

The United Nations Decade of Healthy Ageing is

To address these challenges, efforts are needed to

Many older people lack knowledge about their health

The ICOPE approach provides

Implementing the ICOPE approach in clinical settings

The implementation and scale-up of the ICOPE approach

s trengthening of health and social care systems

Support the coordination MACRO

Orient services towards

Engage and empower

The objective of this ready phase pilot

Focusing on these three levels of implementation readiness for

Usability check Global ﬁeld study Randomized validation

Explore readiness through: Test clinical eﬀectiveness

– Micro survey of health and social

– Meso and macro survey using ICOPE

READY-PHASE METHODS TO ASSESS ICOPE

Community health workers,

Social care workers

FINDINGS FROM THE

SURVEY RESULTS: Local capacity, enablers and barriers to

Upper middle income

STEPS 1 2.1 2.2 2.3 3 4 5

Local needs to implement ICOPE

Need training 75% 70% 70% 70% 75% 64% NA

Need space 30% 40% 37% 47% 39% NA NA

Need administrative support NA NA NA NA NA 44% NA

Availability of ICOPE screening/assessment tool 48% 43% NA NA NA NA NA

Access to essential medicines NA 19% 29% 23% 23% 22% NA

Access to assistive technology NA 29% 30% 22% 30% 23% NA

STEPS 1 2.1 2.2 2.3 3 4 5

Limited space for conducting the evaluation 34 % 40 % 35 % NA NA NA NA

Reaching older people is difficult 17 % NA NA NA NA NA NA

Screening/assessment tool needs to be adapted 33 % 27 % NA 30 % NA NA NA

Lack of infrastructure and system to provide NA NA NA 33 % 52 % NA NA

No information on community activities NA NA NA NA NA NA 37 %

s trengthening of health and social care systems

January to May 2021

Fifteen public health students were trained to

O ngoing since January 2020 (Data to November 2021)

1 711 health and care workers, 410 nurses

L arge urban site

10 903 participants

Ju ne 2020 to August 2021

Over 22 000 health workers, including primary care

L arge urban site