Screening high-risk older adults using self-assessed intrinsic capacity: evidence from real-world ICOPE implementation

BACKGROUND: A basic assessment of intrinsic capacity (IC) deficits in the WHO Integrated Care for Older People (ICOPE) care pathway can be conducted by health and care workers and through self-assessment. This study described the flow of older individuals undertaking ICOPE Step 1 self-assessment through Steps 2 and 3 and examined whether age- and sex-specific normative IC values, previously established from professional evaluations, could identify people at risk of clinical events. METHODS: Community-dwelling adults aged ≥60 from real-world ICOPE implementation who completed Step 1 self-assessments using digital tools were enrolled. IC was calculated using two methods-'WHO Step 1 IC score' and 'visual analogue scale (VAS)-based IC score'-and percentiles were assigned based on IC norms. RESULTS: Between 1 January 2020 and 21 January 2025, 6337 participants (median age 68 [64-73] years; 55.4% women) underwent Step 1 self-assessment. Their distribution of IC percentile groups, determined by both IC score methods, matched the expected ranges. Within 1 year, 161 participants (2.5% of 6337) proceeded to Steps 2-3, of whom 41.0% had baseline IC ≤ the 25th percentile. Having lower IC percentiles at Step 1 was associated with poor nutritional status and self-rated health. Most Step 3 referrals were for cognitive stimulation exercises and lifestyle advice. Among participants with follow-up data, two-thirds switched percentile groups, mostly moving to the nearest higher or lower group. CONCLUSION: Older adults with self-evaluated IC ≤ the 25th percentile tended to require in-depth assessments and care management, supporting the use of IC norms to guide subsequent care.