Intrinsic capacity of older people in the community using WHO Integrated Care for Older People (ICOPE) framework: a cross-sectional study.

BACKGROUND: The World Health Organization (WHO) published the Integrated Care for Older People (ICOPE) framework to guide assessing and promoting intrinsic capacity of older adults. This study, adopting the WHO ICOPE framework, assessed the intrinsic capacity impairment and investigated the relationship among intrinsic capacity, social engagement, and self-care capacity on performing activities of daily living. It also assessed the sensitivity of the initial brief screening and the detailed full assessment. METHODS: This is a cross-sectional study conducted in 11 community centers in Hong Kong. Intrinsic capacity was assessed in two steps identical to WHO ICOPE handbook: using WHO ICOPE brief screening tool (step 1) and detailed full assessment (step 2) to assess the intrinsic capacity domains of locomotion, cognition, vitality, psychological well-being, and sensory capacity (hearing and vision). Structural equational modeling analysis was used to examine the relationship among intrinsic capacity, social engagement, and self-care capacity, and the mediating role of intrinsic capacity in the relationships. RESULTS: A total of 304 older adults with a mean age 76.73 (SD = 7.25) years participated in WHO ICOPE Step 1 brief screening, and 221 participants (72.7%) showed intrinsic capacity impairment. After completing Step 2 full assessment, 202 participants (66.4%) had one or more impaired intrinsic capacity domains. The overall sensitivity and specificity of the screening tool were 95% and 57.6% respectively, whereas the sensitivity of each domain ranged from 74.7% to 100%. The percentage of impairment in locomotion (117, 39.8%), cognition (75, 25.5%), psychological well-being (34, 11.6%), vision (75, 24.7%), hearing capacity (82, 27.9%), and vitality (8, 2.7%). People in younger old age (ß = -0.29, p < 0.001), with more education (ß = 0.26, p < 0.001), and absence of hypertension (ß = -0.11, p < 0.05) were more likely to have better intrinsic capacity. Intrinsic capacity was positively associated with self-care capacity in performing activities of daily living (ß = 0.21, p < 0.001) and social engagement (ß = 0.31, p < 0.001). CONCLUSIONS: The ICOPE screening tool is a sensitive instrument to detect intrinsic capacity impairment among community-dwelling older adults and it does not demand substantial workforce; its use is worthy to be supported. The intrinsic capacity impairment in community-dwelling older adults are prevalent, in particular, in locomotor and cognitive capacity. Actions should be taken to slow or prevent the impairment, support self-care and social engagement in old age.

Gains and development of undergraduate nursing students during a 2-year community service program.

Service-learning has long been regarded as a teaching strategy that promotes student learning while simultaneously contributing to the community. This article reports the service-learning experience of undergraduate nursing students who participated in a project with two nongovernmental organizations that enabled students to visit disadvantaged older adults on a regular basis. Fifty-two students were recruited to join the study. A content analysis of their reflective journals regarding their service-learning experience was performed. The texts were compared on the basis of their differences and similarities, sorted into categories, and then abstracted into themes. Four themes were identified: "I have learned a lot," "I have changed over time," "My perception of older people has changed," and "I have learned through experience." The students gained valuable experience from this project during a 2-year period. The main learning outcome was improved communication skills. The experience also promoted students' personal growth and professional development.