Why are the ICOPE guidelines needed? Universal health coverage is the foundation for achieving the United Nations Sustainable Development Goal number 3 (SDG 3), for health and well-being. Without considering the health and social care needs of the ever-increasing numbers of older people, SDG 3 will be impossible to achieve. Currently, health systems are often better designed to respond to episodic health needs than to the more complex and chronic health needs that tend to arise with increasing age. There is an urgent need to develop and implement comprehensive and coordinated primary health care approaches that can prevent, slow or reverse declines in intrinsic capacity, and, where these declines are unavoidable, help older people to compensate in ways that maximize their functional ability. Integrated-care approaches should be community-based, designed around the needs of the older person rather than the provider, and coordinated effectively with long-term care systems.#
- comprehensive assessment of health status in an older person - delivery of the integrated health care that will enable an older person to maintain their physical and mental capacities, and/or to slow or reverse any declines in these - delivery of interventions to support caregivers.
The ICOPE guidelines will assist health care professionals in clinical settings to detect declines in physical and mental capacities and to deliver effective interventions to prevent and delay progression. National guidance will also benefit from drawing on these ICOPE guidelines. The ICOPE guidelines can inform the inclusion of Healthy Ageing interventions in the basic benefits package for pursuing universal health coverage.

# How to deliver integrated care for older people (ICOPE)?
Services need to be orientated around the needs of older people rather than the needs of the services themselves. Services should respond to a diversity of older people that ranges from those with high and stable levels of intrinsic capacity through those with declining capacity, to people whose capacity has deteriorated to the point of needing the care and support of others. Delivering ICOPE can support a transformation in the way health systems are designed and operate. Important elements of integrated care at the community level are:
- a comprehensive assessment and care plan shared with all providers - common care and treatment goals across different providers - community outreach and home-based interventions - support for self-management - comprehensive referral and monitoring processes - community engagement and caregiver support.

# Multimodal exercise, including progressive strength resistance training
and other exercise components (balance, flexibility and aerobic training) should be recommended for older people with declining physical capacity, measured by gait speed, grip strength and other physical performance measures 2. Oral supplemental nutrition with dietary advice should be recommended for older people affected by undernutrition Loss of muscle mass and strength, reduced flexibility, and problems with balance can all impair mobility. Nutritional status can also be affected negatively by physiological changes that can accompany ageing, in turn with an impact on vitality and mobility.
Interventions that improve nutrition and encourage physical exercise, when integrated into care plans and delivered together, can slow, stop or reverse declines in intrinsic capacity.
Older people should receive routine screening for visual impairment in the primary care setting, and timely provision of comprehensive eye care 4. Screening followed by provision of hearing aids should be offered to older people for timely identification and management of hearing loss Ageing is often associated with loss of hearing and/or vision that limits mobility, social participation and engagement, and can increase the risk of falls. Sensory problems could easily be addressed by simple and affordable strategies such as the provision of corrective glasses and hearing aids, cataract surgery and environmental adaptations. WHO defines intrinsic capacity as the composite of all the physical and mental capacities of an individual; and functional ability as the combination and interaction of intrinsic capacity with the environment a person inhabits.

# Manage age-associated conditions such as urinary incontinence

# Prevent falls
- Psychological intervention, training and support should be offered to family members and other informal caregivers of care-dependent older people, particularly but not exclusively when the need for care is complex and extensive and/or there is significant caregiver strain Caregivers of people with severe declines in intrinsic capacity are at a higher risk of experiencing psychological distress and depression themselves. Caregiving stress or burden has a profound impact on the physical, emotional and economic status of women and other unpaid caregivers. A needs assessment and access to psychosocial support and training should be offered to caregivers experiencing stress.

# Support caregivers
Recommendations for managing declines in intrinsic capacity in older people