The WHO Department of Ageing and Life Course is grateful to the members of the WHO systematic review team: Alessandra Stella (Independent Consultant, Rome, Italy); Kralj Carolina (King's College London, London, United Kingdom); Meredith Fendt-Newlin (King's College London, London, United Kingdom).
King's College London, London, United Kingdom, supported the development of the ICOPE guidelines by providing staff to work on the systematic reviews and assisting in the management of the GDG. King's College London did not receive any external funding for engaging with WHO on the development of these guidelines. Finally, the peer-reviewers are due thanks for their thoughtful feedback of a preliminary version of these guidelines.
The WHO Department of Ageing and Life Course acknowledges the financial support of the Government of Japan for the development of the ICOPE guidelines. Donors do not fund specific guidelines and do not participate in any decision related to the guideline development process, including for the composition of research questions, the memberships of the guideline groups, the conduct and interpretation of systematic reviews, or the formulation of the recommendations.
Editing, design and layout were provided by Green Ink, United Kingdom (greenink.co.uk). Over the past 50 years, socioeconomic development in most regions has been accompanied by large reductions in fertility and equally dramatic increases in life expectancy. This phenomenon has led to rapid changes in the demographics of populations around the world: the proportion of older people in general populations has increased substantially within a relatively short period of time.
Numerous underlying physiological changes occur with increasing age, and for older people the risks of developing chronic disease and care dependency increase. By the age of 60 years, the major burden of disability and death arises from age-related losses in hearing, seeing and moving, and conditions such as dementia, heart disease, stroke, chronic respiratory disorder, diabetes and musculoskeletal conditions such as osteoarthritis and back pain.
The 2015 World Health Organization (WHO) World report on ageing and health defines the goal of Healthy Ageing as helping people in "developing and maintaining the functional ability that enables wellbeing". Functional ability is defined in the report as the "health-related attributes that enable people to be and to do what they have reason to value". Intrinsic capacity, finally, is "the composite of all of the physical and mental capacities that an individual can draw on". The WHO public health framework for Healthy Ageing focuses on the goal of maintaining intrinsic capacity and functional ability across the life course.
Health care professionals in clinical settings can detect declines in physical and mental capacities (clinically expressed as impairments) and deliver effective interventions to prevent and delay progression. Yet early markers of declines in intrinsic capacity, such as decreased gait speed or muscle strength, are often not identified, treated or monitored, which are crucial actions if these declines are to be reversed or delayed. The majority of health care professionals lack guidance or training to recognize and manage impairments in older age. There is a pressing need to develop comprehensive community-based approaches and to introduce interventions at the primary health care level to prevent declines in capacity. These guidelines address this need.
The recommendations provided here on integrated care for older people (ICOPE) offer evidence-based guidance to health care providers on the appropriate approaches at the community level to detect and manage important declines in physical and mental capacities, and to deliver interventions in support of caregivers. These standards can act as the basis for national guidelines and for the inclusion of older people's health care in primary care programmes, using a person-centred and integrated approach.