A short list of high-priority indicators of health system responsiveness for aging: an eDelphi consensus study.

The objective of this article was to provide a consensus-based short list of effective indicators to measure health system responsiveness to the needs of older adults which would be relevant to informing public policy. An e-Delphi study was done with no direct interaction between respondents. Virtual surveys were sent to 141 participants with experience in analysis and monitoring of health indicators, management of health systems, and health care of older adults. A baseline list of 24 previously published indicators was used. The criteria for selection as high priority indicators were: usefulness as a tracer of health system responsiveness and usefulness to inform policy. Consensus was defined as: ≥70% agreement among the participants that the indicator was very high or high priority; plus being benchmarked by ≥50% of respondents as having a higher relative weight than other indicators; plus being in the top 10 in the ranking list. The first round of the process included 38 participants with varied professional backgrounds. Consensus was reached for seven indicators after two rounds. Five indicators were related to distal outcomes (mortality, disability, or healthy life expectancy), one to monitoring functional assessments, and one to poverty levels. Health systems professionals should consider these comprehensive priority indicators in their efforts to provide a better health system for older people.

El objetivo de este artículo es proporcionar una lista breve y consensuada de indicadores eficaces para medir la capacidad de respuesta del sistema de salud al atender las necesidades de las personas mayores que sean pertinentes para fundamentar las políticas públicas. Se realizó un estudio con el uso de eDelphi (el software para el método de Delfos), sin interacción directa entre las personas encuestadas. Se enviaron encuestas virtuales a 141 participantes con experiencia en el análisis y el seguimiento de indicadores de salud, la gestión de sistemas de salud y la atención de salud de las personas mayores. Se utilizó una lista de referencia de 24 indicadores publicada con anterioridad. Los criterios para seleccionar los indicadores de alta prioridad fueron: utilidad como elemento de medición de la capacidad de respuesta de los sistemas de salud y utilidad para fundamentar las políticas. El consenso se definió como lo siguiente: un acuerdo ≥70% entre los participantes de que el indicador era de prioridad muy alta o alta; que ≥50% de los encuestados consideraran que tenía un mayor peso relativo que otros indicadores; y que estuviera entre los diez primeros lugares de la lista. En la primera ronda del proceso intervinieron 38 participantes con distintas competencias profesionales. Después de dos rondas, se llegó a un consenso respecto a siete indicadores. Cinco indicadores estaban relacionados con resultados a largo plazo (mortalidad, discapacidad o esperanza de vida sana), uno con el seguimiento de evaluaciones funcionales y uno con los niveles de pobreza. Los profesionales de los sistemas de salud deberían tener en cuenta estos indicadores prioritarios integrales al adoptar medidas tendientes a proporcionar un mejor sistema de salud para las personas mayores.

Este artigo tem como objetivo fornecer uma breve lista consensual de indicadores efetivos para medir a capacidade de resposta de sistemas de saúde às necessidades das pessoas idosas, relevante para informar políticas públicas. Foi realizado um estudo eDelphi sem interação direta entre os entrevistados. Questionários virtuais foram enviados a 141 participantes com experiência em análise e monitoramento de indicadores de saúde, gestão de sistemas de saúde e atenção à saúde de pessoas idosas, tendo como base uma lista de 24 indicadores publicados anteriormente. Os critérios para seleção como indicadores de alta prioridade foram sua utilidade como marcador da capacidade de resposta do sistema de saúde e utilidade para informar políticas públicas. O consenso foi definido como: ≥70% de concordância entre os participantes de que o indicador tinha prioridade muito alta ou alta; avaliação por ≥50% dos entrevistados de que tinha um peso relativo maior do que outros indicadores; e posicionamento entre os 10 primeiros na lista de classificação. A primeira rodada do processo incluiu 38 participantes com diversos perfis profissionais. Após duas rodadas, chegou-se a um consenso sobre sete indicadores. Cinco estavam relacionados a resultados distais (mortalidade, incapacidade ou expectativa de vida saudável), um ao monitoramento de avaliações funcionais e o último aos níveis de pobreza. Os profissionais de sistemas de saúde devem considerar esses indicadores prioritários abrangentes em seus esforços para oferecer um sistema de saúde melhor para as pessoas idosas.

The sensitivity and specificity of the WHO's ICOPE screening tool, and the prevalence of loss of intrinsic capacity in older adults: A scoping review.

BACKGROUND: The World Health Organization has developed the Integrated Care for Older People (ICOPE) program, a public health strategy to maintain older adults' functional abilities and promote healthier aging. The approach comprises a 5-step pathway. Step 1 is the screening for impairment in functions, and Step 2 is an in-depth evaluation to confirm the presence and severity of functional impairment. These initial two steps are crucial to determine the subsequent plan of care (Step 3) and follow-up (Step 4). The fifth step encompasses actions to support families and caregivers and to engage communities. This review gathers data from the literature on the prevalence of positive screenings regarding intrinsic capacity detected by the program's first-step screening tool, and on currently available results regarding the instrument's sensitivity and specificity. METHODS AND FINDINGS: Electronic searches were conducted in the PubMed, Cochrane, Embase, and SciElo databases, the medRxiv platform, and recent human aging scientific events, looking for research analyzing the ICOPE screening instrument. Studies reporting data on the prevalence of positive screenings for loss of intrinsic capacity using the proposed screening tool and/or findings on the instrument's sensitivity and specificity were included. A total of 7 publications with participants aged 50 years or more were selected. The prevalence of at least one impairment in intrinsic capacity detected by the instrument varied among the studies from 17.1 % to 94.3 %. Sensitivity ranged from 26.4 % to 100 % and specificity from 22 % to 96 %, depending on the setting and the assessed domain. CONCLUSION: Currently available data are heterogeneous, and different results were found among the studies due to diverse settings and methodologies. The evidence on the ICOPE screening tool's performance in different populations is still scarce and reinforces the need for further research worldwide.

A short list of high-priority indicators of health system responsiveness for aging: an eDelphi consensus study

[ABSTRACT]. The objective of this article was to provide a consensus-based short list of effective indicators to measure health system responsiveness to the needs of older adults which would be relevant to informing public policy. An e-Delphi study was done with no direct interaction between respondents. Virtual surveys were sent to 141 participants with experience in analysis and monitoring of health indicators, management of health systems, and health care of older adults. A baseline list of 24 previously published indicators was used. The criteria for selection as high priority indicators were: usefulness as a tracer of health system responsiveness and useful- ness to inform policy. Consensus was defined as: ≥70% agreement among the participants that the indicator was very high or high priority; plus being benchmarked by ≥50% of respondents as having a higher relative weight than other indicators; plus being in the top 10 in the ranking list. The first round of the process included 38 participants with varied professional backgrounds. Consensus was reached for seven indicators after two rounds. Five indicators were related to distal outcomes (mortality, disability, or healthy life expectancy), one to monitoring functional assessments, and one to poverty levels. Health systems professionals should consider these comprehensive priority indicators in their efforts to provide a better health system for older people.

[RESUMEN]. El objetivo de este artículo es proporcionar una lista breve y consensuada de indicadores eficaces para medir la capacidad de respuesta del sistema de salud al atender las necesidades de las personas mayores que sean pertinentes para fundamentar las políticas públicas. Se realizó un estudio con el uso de eDelphi (el software para el método de Delfos), sin interacción directa entre las personas encuestadas. Se enviaron encuestas virtuales a 141 participantes con experiencia en el análisis y el seguimiento de indicadores de salud, la gestión de sistemas de salud y la atención de salud de las personas mayores. Se utilizó una lista de referencia de 24 indicadores publicada con anterioridad. Los criterios para seleccionar los indicadores de alta prioridad fueron: utilidad como elemento de medición de la capacidad de respuesta de los sistemas de salud y utilidad para fundamentar las políticas. El consenso se definió como lo siguiente: un acuerdo ≥70% entre los participantes de que el indicador era de prioridad muy alta o alta; que ≥50% de los encuestados consideraran que tenía un mayor peso relativo que otros indicadores; y que estuviera entre los diez primeros lugares de la lista. En la primera ronda del proceso intervinieron 38 participantes con distintas competencias profesionales. Después de dos rondas, se llegó a un consenso respecto a siete indicadores. Cinco indicadores estaban relacionados con resultados a largo plazo (mortalidad, discapacidad o esperanza de vida sana), uno con el seguimiento de evaluaciones funcionales y uno con los niveles de pobreza. Los profesionales de los sistemas de salud deberían tener en cuenta estos indicadores prioritarios integrales al adoptar medidas tendientes a proporcionar un mejor sistema de salud para las personas mayores.

[RESUMO]. Este artigo tem como objetivo fornecer uma breve lista consensual de indicadores efetivos para medir a capacidade de resposta de sistemas de saúde às necessidades das pessoas idosas, relevante para informar políticas públicas. Foi realizado um estudo eDelphi sem interação direta entre os entrevistados. Questionários virtuais foram enviados a 141 participantes com experiência em análise e monitoramento de indicadores de saúde, gestão de sistemas de saúde e atenção à saúde de pessoas idosas, tendo como base uma lista de 24 indicadores publicados anteriormente. Os critérios para seleção como indicadores de alta prioridade foram sua utilidade como marcador da capacidade de resposta do sistema de saúde e utilidade para infor- mar políticas públicas. O consenso foi definido como: ≥70% de concordância entre os participantes de que o indicador tinha prioridade muito alta ou alta; avaliação por ≥50% dos entrevistados de que tinha um peso relativo maior do que outros indicadores; e posicionamento entre os 10 primeiros na lista de classificação. A primeira rodada do processo incluiu 38 participantes com diversos perfis profissionais. Após duas rodadas, chegou-se a um consenso sobre sete indicadores. Cinco estavam relacionados a resultados distais (mortal- idade, incapacidade ou expectativa de vida saudável), um ao monitoramento de avaliações funcionais e o último aos níveis de pobreza. Os profissionais de sistemas de saúde devem considerar esses indicadores pri- oritários abrangentes em seus esforços para oferecer um sistema de saúde melhor para as pessoas idosas.

Exploring the natural history of intrinsic capacity impairments: longitudinal patterns in the 10/66 study.

BACKGROUND: intrinsic capacity (IC) is a construct encompassing people's physical and mental abilities. There is an implicit link amongst IC domains: cognition, locomotion, nutrition, sensory and psychological. However, little is known about the integration of the domains. OBJECTIVES: to investigate patterns in the presentation and evolution of IC domain impairments in low-and-middle-income countries and if such patterns were associated with adverse outcomes. METHODS: secondary analyses of the first two waves of the 10/66 study (population-based surveys conducted in eight urban and four rural catchment areas in Cuba, Dominican Republic, Puerto Rico, Venezuela, Peru, Mexico and China). We applied latent transition analysis on IC to find latent statuses (latent clusters) of IC domain impairments. We evaluated the longitudinal association of the latent statuses with the risk of frailty, disability and mortality, and tested concurrent and predictive validity. RESULTS: amongst 14,923 participants included, the four latent statuses were: high IC (43%), low deterioration with impaired locomotion (17%), high deterioration without cognitive impairment (22%), and high deterioration with cognitive impairment (18%). A total of 61% of the participants worsened over time, 35% were stable, and 3% improved to a healthier status.Participants with deteriorated IC had a significantly higher risk of frailty, disability and dementia than people with high IC. There was strong concurrent and predictive validity. (Mortality Hazard Ratio = 4.60, 95%CI 4.16; 5.09; Harrel's C = 0.73 (95%CI 0.72;0.74)). CONCLUSIONS: half of the study population had high IC at baseline, and most participants followed a worsening trend. Four qualitatively different IC statuses or statuses were characterised by low and high levels of deterioration associated with their risk of disability and frailty. Locomotion and cognition impairments showed other trends than psychological and nutrition domains across the latent statuses.

Investigating three ways of measuring the intrinsic capacity domain of vitality: nutritional status, handgrip strength and ageing biomarkers.

BACKGROUND: Vitality is conceptually considered as the underlying capacity influencing other intrinsic capacity (IC) domains and being related to nutrition, physiological reserve and biological ageing. However, there is no consensus on its operationalisation. OBJECTIVE: To investigate the structure and magnitude of the association of vitality with other IC domains and functional difficulties using three operational definitions of vitality. METHODS: We included 1,389 older adults from the Multidomain Alzheimer Preventive Trial with data on Mini Nutritional Assessment (MNA), handgrip strength and plasma biomarkers (comprising inflammatory and mitochondrial markers). Using path analysis, we examined the effects of vitality on difficulties in basic and instrumental activities of daily living (ADL and IADL) exerted directly and indirectly through the mediation of other IC domains: cognition, locomotion, psychological, vision and hearing. We further explored the longitudinal association of vitality with IC domains, ADL and IADL over 4 years using linear mixed-effect regression. RESULTS: We observed significant indirect effects of vitality on IADL, mainly through cognitive, locomotor and psychological domains, regardless of the vitality measurement. Participants with higher vitality had fewer IADL difficulties at follow-up (MNA score: ß [95% CI] = -0.020 [-0.037, -0.003]; handgrip strength: -0.011 [-0.023, 0.000]; plasma biomarker-based index: -0.015 [-0.028, -0.002]). Vitality assessed with the plasma biomarker-based index predicted improved locomotion over time. CONCLUSION: Vitality was associated with disability primarily through the mediation of other IC domains. The three indicators examined are acceptable measurements of vitality; biomarkers might be more suitable for the early detection of locomotion decline.

Associations between Vitality/Nutrition and the Other Domains of Intrinsic Capacity Based on Data from the INSPIRE ICOPE-Care Program.

BACKGROUND: The vitality domain of intrinsic capacity (IC) represents the synthesis of biological interactions and metabolism. As part of the Integrated Care for Older People (ICOPE) program developed by the World Health Organization (WHO), vitality focuses on the nutritional status of older adults. The objective of this work was to describe the vitality domain of IC in community-dwelling older people and to examine the associations of the vitality components (appetite loss and weight loss) with the other IC domains assessed within the framework of ICOPE. METHODS: Cross-sectional data were obtained between January 2020 and February 2022 through the INSPIRE-ICOPE-Care program, a real-life ICOPE implementation initiative developed in the Occitania region of France. Participants were men and women aged 60 and older, looking for primary care services within the French healthcare system. RESULTS: Appetite loss was reported by 14.0% (2013) of the participants, and weight loss by 12.4% (1788). A total of 863 participants (6.01%) declaring weight loss also suffered from appetite loss. In total, 2910 participants (20.27%) screened positive for the domain of vitality. Appetite loss was significantly associated with positive screenings for the domains of cognition (OR = 2.14 [1.84;2.48]), vision (OR = 1.51 [1.28;1.79]), hearing (OR = 1.18 [1.01;1.37]), psychology (OR = 3.95 [3.46;4.52]), and locomotion 'OR = 2.19 [1.91;2.51]). We found significant associations of weight loss with the IC domains of cognition (OR = 1.65 [1.42;1.93]), psychology (OR = 1.80 [1.56;2.07]), locomotion (OR = 1.64 [1.41;1.91]), vision (OR = 1.24 [1.04;1.47]), and hearing (OR = 1.32 [1.12;1.55]). People reporting simultaneous appetite and weight loss showed higher odds of screening positive for psychological (OR = 5.33 [4.53;6.27]) and locomotion impairments (OR = 3.38 [2.88;3.98]). CONCLUSIONS: Appetite and weight loss are common among older people and are related to other potential IC impairments, especially psychological and locomotion. Further studies are needed to explore the longitudinal associations of vitality with the incidence of clinically meaningful declines in the other IC domains.

Plasma inflammation-related biomarkers are associated with intrinsic capacity in community-dwelling older adults.

BACKGROUND: How inflammation relates to intrinsic capacity (IC), the composite of physical and mental capacities, remains undefined. Our study aimed to investigate the cross-sectional and longitudinal associations between plasma inflammation-related biomarkers and IC in older adults. METHODS: This secondary analysis of the Multidomain Alzheimer Preventive Trial (MAPT) included 1238 community-dwelling older individuals with IC assessments from 12 to 60 months. Plasma C-reactive protein (CRP), interleukin-6 (IL-6), tumour necrosis factor receptor-1 (TNFR-1), monocyte chemoattractant protein-1 (MCP-1) and growth differentiation factor-15 (GDF-15) were measured at 12 months. IC was operationalized as a score ranging from 0 to 100, derived from four domains: cognition, Mini-Mental State Examination; locomotion, Short Physical Performance Battery; psychological, Geriatric Depression Scale; and vitality, handgrip strength. A five-domain IC score (plus sensory) was investigated in a subsample (n = 535) with a 1-year follow-up as an exploratory outcome. RESULTS: The mean age of the 1238 participants was 76.2 years (SD = 4.3); 63.7% were female. Their initial four-domain IC scores averaged 78.9 points (SD = 9.3), with a yearly decline of 1.17 points (95% CI = -1.30 to -1.05; P < 0.001). We observed significant associations of lower baseline IC with higher CRP, IL-6, TNFR-1 and GDF-15, after controlling age, sex, MAPT group allocation and educational level [CRP: adjusted ß (95% CI) = -1.56 (-2.64 to -0.48); P = 0.005; IL-6: adjusted ß = -3.16 (-4.82 to -1.50); P < 0.001; TNFR-1: adjusted ß = -6.86 (-10.25 to -3.47); P < 0.001; GDF-15: adjusted ß = -7.07 (-10.02 to -4.12); P < 0.001]. Higher TNFR-1, MCP-1 and GDF-15 were associated with faster decline in four-domain IC over 4 years [TNFR-1: adjusted ß (95% CI) = -1.28 (-2.29 to -0.27); P = 0.013; MCP-1: adjusted ß = -1.33 (-2.24 to -0.42); P = 0.004; GDF-15: adjusted ß = -1.42 (-2.26 to -0.58); P = 0.001]. None of the biomarkers was significantly associated with the five-domain IC decline. CONCLUSIONS: Inflammation was associated with lower IC in older adults. Among all plasma biomarkers, TNFR-1 and GDF-15 were consistently associated with IC at the cross-sectional and longitudinal levels.

Development and Validation of a Cutoff for the Chair Stand Test as a Screening for Mobility Impairment in the Context of the Integrated Care for Older People Program.

BACKGROUND: The 5-repetition chair stand test (CST) is increasingly being used to assess locomotion capacity in older adults. However, there is a lack of age-stratified cutoffs for adults aged ≥70 validated against a higher risk of functional loss. METHODS: We used 2 population-based studies (Study on global AGEing and adult health in Mexico [SAGE Mexico] and Toledo Study for Healthy Aging [TSHA]) and receiver operating characteristic (ROC) analyses to develop and cross-validate age-stratified chair stand cutoffs with activities of daily living (ADL) disability as the outcome. Then, we used data from an randomized controlled trial (RCT) (Multidomain Alzheimer Preventive Trial [MAPT]) and a frailty day-hospital for external validation with cross-sectional and longitudinal measures of ADL disability. The merged sample of SAGE Mexico and TSHA was n = 1 595; sample sizes for external validation were: MAPT n = 1 573 and Frailty day-hospital n = 2 434. The Cox models for incident disability in MAPT had a mean follow-up of 58.6 months. RESULTS: Cutoffs obtained were 14 second (ages 70-79) and 16 second (ages 80+). Those cutoffs identified older adults at higher odds of incident ADL disability odds ratio (OR) = 1.72 (95% confidence interval [CI] 1.06; 2.78) for ages 70-79 and odds ratio (OR) = 2.27 (95% CI 1.07; 4.80) in those aged 80+. Being a slow chair stander according to the cut points was associated with ADL disability in cross-sectional and longitudinal measures. CONCLUSIONS: Fourteen- and 16-second cut points for the CST are suitable to identify people at higher risk of functional decline among older adults in Mexico and Toledo, Spain. Adjusting the cut point from 14 to 16 second generally improved the psychometric properties of the test. The validation of these cutoffs can facilitate the screening for limited mobility and the implementation of the Integrated Care for Older People program.

Clinically meaningful change for the chair stand test: monitoring mobility in integrated care for older people.

BACKGROUND: Clinically meaningful changes in the five-repetition chair stand test are essential for monitoring mobility in integrated care for older people. Recommendations for the clinically meaningful change of the chair stand test are not well known. Our study aimed to estimate the absolute and relative clinically meaningful changes for older adults' five-repetition chair stand test. METHODS: We applied distribution-based and anchor-based methods in addition to receiver operator characteristics analyses to a population-based study of community-dwelling adults (SAGE Mexico study, n = 897) to derive the clinically meaningful change in the chair stand test. We used three self-reported clinical anchors: moving around, vigorous activities, and walking 1 km. Our primary outcome was the incidence of disability for basic activities of daily living (ADL). Secondly, we examined our estimates of clinically meaningful change in a clinical trial population of healthy volunteers (MAPT, France, study n = 1575) concerning the risk of incident ADL disability. RESULTS: The age of SAGE Mexico participants ranged from 60 to 96 years; mean (SD) = 69.0 (6.2); 54.4% were female. Their baseline chair stand time averaged 12.1 s (SD = 3 s). Forty-eight participants (5.6%) showed incident disability over 3 years. The absolute and relative clinically meaningful change cut points found over 3 years of follow-up were 2.6 s and 27.7%, respectively. Absolute clinically meaningful change ranged from 0.5 to 4.7 s, depending on the estimation method. Relative clinically meaningful change ranged from 9.6 to 46.2%. SAGE Mexico participants with absolute and relative clinically meaningful declines (increasing 2.6 s and 27.7% from baseline time, respectively) showed an increased risk of ADL disability [aRR = 1.93; P = 0.0381; 95% CI (1.05, 3.46) and aRR = 2.27; P = 0.0157; 95% CI (1.22, 4.10)], respectively, compared with those without a clinically meaningful decline. MAPT participants [age range = 70-94; mean (SD) = 75.3 (4.4); 64.8% female; incident ADL disability over 5 years = 145(14.8%)] with a relative clinically meaningful decline (≥27.7% from baseline over 3 years) had a 74% higher risk of incident ADL disability than their counterparts [aHR = 1.74; P = 0.016; CI95% (1.11, 2.72); mean follow-up of 58 months]. CONCLUSIONS: Community-dwelling older adults with an increase of 3 s or 28% in chair stand test performance over 3 years (approximately 1 s or 10% per year) could be the target of interventions to enhance mobility and prevent incident disability.

Longitudinal trajectories of intrinsic capacity and their association with quality of life and disability.

OBJECTIVES: Intrinsic capacity (IC) is a key concept within the World Health Organization's (WHO) healthy aging model. The systematic assessment of IC could provide a better understanding of the functional trajectories of individuals. Our aims were to identify the longitudinal trajectories of IC and estimate their association with quality of life and disability. STUDY DESIGN: The study data comes from the three waves of the WHO Study on global AGEing and adult health (SAGE) in Mexico (2009, 2014, 2017). In total, 2735 adults aged 50 years or more were included. An IC score was constructed using item response theory. We used growth mixture modeling (GMM) to investigate the longitudinal trajectories of IC. Three-level linear mixed effect models were used to estimate the associations of IC with quality of life and disability. MAIN OUTCOME MEASURES: Disability was measured using the WHO Disability Assessment Schedule (WHODAS 2.0) and quality of life using the WHOQOL (WHO Quality of Life) instrument. RESULTS: Three classes were identified: low baseline IC with a steeply decreasing trajectory, medium baseline IC with a slightly decreasing trajectory, and high baseline IC with a moderately increasing trajectory. The class with the better trajectory (higher baseline IC score and a moderately increasing pattern) exhibited higher quality-of-life scores and lower disability scores. CONCLUSIONS: The findings show that older Mexican adults exhibit different IC trajectories, and that these may be associated with quality of life and disability. Results highlight the need for health policies and strategies to maintain intrinsic capacity and to promote primary prevention.

Screening for deficits on intrinsic capacity domains and associated healthcare costs.

BACKGROUND/OBJECTIVE: Intrinsic capacity (IC) defined by the World Health Organization is divided into six domains (locomotion, psychological, vitality/nutrition, cognition, vision and hearing). The main objective of this study therefore is to explore the association between healthcare costs and IC domains deficits among older patients. PARTICIPANTS AND SETTING: This longitudinal secondary analysis was performed on data from the Multidomain Alzheimer Preventive Trial (MAPT), a 3-year randomized controlled trial with non-demented community-dwelling participants aged 70 years or over. METHODS: We used an adapted version of the ICOPE (Integrated Care for Older People) Step 1 to screen for the six operational IC domains deficits at three time-points: baseline, one year and two years. We performed bivariate and multivariate analyzes using generalized linear models and generalized estimating equation models to identify associations between healthcare cost and deficits on IC domains. RESULTS: We analyzed 693 patients (aged 75.2 ± 4.22 years; 64% women (N = 442)). At baseline, among the included patients, 89% had at least one impairment in IC domains (N = 619). A deficit on visual capacity was associated with increased immediate healthcare costs (CR: 1.48; 95CI: [1.16-1.89]). Regarding persistent impairment of IC, locomotor (CR: 1.27; 95CI: [1.01-1.60], additional annual healthcare cost: €1092 per patient) and psychological (CR: 1.28; 95CI: [1.03-1.59], additional annual healthcare cost: €817 per patient) capacities were associated with increased healthcare costs. CONCLUSION: In conclusion, this study showed that some deficits on IC domains, as measured by simple screening tests and questions, can be associated with higher healthcare costs. CLINICALTRIALS: gov identifier: NCT00672685.

Functional Dependency in Mexico: Measurement Issues and Policy Challenges.

BACKGROUND: Different definitions have been used to measure functional dependency (FD) in Mexico. This study aims to explore if different definitions of FD lead to low consistency between the estimations of its prevalence. Accurate estimations of FD are useful to estimate the potential demand for long-term care (LTC) services in the country. METHODS: A literature review including documents with estimations on the number or prevalence of dependents in Mexico with national representativeness between 2000 and 2019 was performed as well as estimations of different definitions of FD, using the National Study on Health and Aging in Mexico (ENASEM). RESULTS: There is a lack of consensus on the definition of FD. Among the most frequently used terms to define FD are "disability" and "dependency." The heterogeneity of definitions results in a wide range of estimations of the demand for LTC. Methodological choices can lead to important differences in FD prevalence estimations. Results from ENASEM 2001 show that FD prevalence could range from 13% to 35% in people 60+; sex prevalences also vary when using different ways to measure FD. CONCLUSION: Besides the highlighted issues in calculating FD in the population, Mexico should consider broadening the assessment of FD, including people with dementia and younger populations. Although the literature search is not systematic, it helps exemplifying the current issues when measuring FD in Mexico. A consensual definition of dependency is required to have a more accurate estimated demand for LTC. Having good data sources is not enough when dissimilar estimations of an indicator like dependency result from the same study. Wide heterogeneity in estimations of dependency could be an obstacle to inform public policies during the construction of a care system in Mexico.

Assessing health system responsiveness to the needs of older people.

OBJECTIVE: To identify key indicators that will allow empirical measurement of a health system's responsiveness to older people. METHODS: We conducted a series of consultations with experts to develop a relevant list of indicators. Concept mapping was used to devise the list, including the steps of preparation, brainstorming and structuring. Additionally, four countries were used as national case studies to test the feasibility of measuring health system responsiveness with readily available national-level data (Barbados, Brazil, Chile, and Mexico). RESULTS: Our study resulted in a list of 25 indicators scored with high usefulness for informing public policy, 10 of which were also categorized as being of high availability. National case studies were useful to assess the feasibility of measuring health system responsiveness in different settings. CONCLUSIONS: Responsiveness can be comprehensively assessed by (i) approaching the intrinsic features of the system via its inputs, outputs, and outcomes, and (ii) measuring the impact of the system on meeting the needs of older people in terms of their health, financial protection, and expectations. Further consensus is needed to develop a list of core indicators that could be used as a baseline for measuring a health system's responsiveness to the needs of older people.

Implementing long-term care systems in the Americas: a regional strategy.

The Region of the Americas is facing accelerated demographic and epidemiological changes. As these trends will continue in future years, long-term care needs are expected to rise. How can countries respond to these challenges? We propose that countries in the Region should invest in the implementation of long-term care systems. Considering the heterogeneity in the Region, we propose a strategy based on three components: (i) understanding the problem; (ii) thinking about solutions; and (iii) building support and consensus. Depending on each country's needs and capacities, these three elements suggest short-term and long-term actions and goals, from generating better information on long-term care needs to the implementation of long-term care systems. Long-term care is a relevant issue for the Region today. The task is challenging, but countries need to embrace it and move forward before it is too late.

La Región de las Américas está haciendo frente a acelerados cambios demográficos y epidemiológicos. Considerando que estas tendencias se mantendrán en los años venideros, se prevé que la necesidad de cuidados a largo plazo se incrementará. ¿Cómo pueden responder los países a estos retos?Proponemos que los países de la Región inviertan en el establecimiento de sistemas de cuidados a largo plazo. Considerando la heterogeneidad de la Región, proponemos una estrategia fundamentada en tres componentes: a) comprender el problema; b) pensar en soluciones; y c) generar apoyo y consenso. De acuerdo con las necesidades y las capacidades de cada país, estos tres elementos determinan los objetivos y las medidas a corto y largo plazo, desde la producción de mejor información sobre las necesidades de cuidados a largo plazo hasta el establecimiento de sistemas de cuidados a largo plazo.Hoy en día, los cuidados a largo plazo son una cuestión pertinente en la Región. Aunque esta tarea represente un reto, los países deben aceptarlo y progresar antes de que sea demasiado tarde.

A Região das Américas encontra-se em transição demográfica e epidemiológica acelerada. Esta tendência deve persistir nos próximos anos e antecipa-se um crescimento da demanda por assistência a longo prazo. Como os países podem enfrentar estes desafios?A nossa proposta é que os países das Américas invistam na implementação de sistemas de assistência a longo prazo. Como a Região se caracteriza pela heterogeneidade entre os países, propomos uma estratégia alicerçada em três componentes: (i) entender o problema, (ii) buscar soluções e (iii) granjear apoio e consenso. Dependendo das necessidades e da capacidade de cada país, esses três componentes devem servir para estabelecer metas e ações a curto ou longo prazo, que vão desde aprofundar o conhecimento sobre as necessidades existentes a implementar os sistemas em si. A assistência a longo prazo é uma questão atual de interesse para a Região. A tarefa envolve muitos desafios, mas os países precisam encampá-la e avançar antes que seja tarde demais.

Assessing health system responsiveness to the needs of older people

[ABSTRACT]. Objective. To identify key indicators that will allow empirical measurement of a health system’s responsiveness to older people. Methods. We conducted a series of consultations with experts to develop a relevant list of indicators. Concept mapping was used to devise the list, including the steps of preparation, brainstorming and structuring. Additionally, four countries were used as national case studies to test the feasibility of measuring health system responsiveness with readily available national-level data (Barbados, Brazil, Chile, and Mexico). Results. Our study resulted in a list of 25 indicators scored with high usefulness for informing public policy, 10 of which were also categorized as being of high availability. National case studies were useful to assess the feasibility of measuring health system responsiveness in different settings. Conclusions. Responsiveness can be comprehensively assessed by (i) approaching the intrinsic features of the system via its inputs, outputs, and outcomes, and (ii) measuring the impact of the system on meeting the needs of older people in terms of their health, financial protection, and expectations. Further consensus is needed to develop a list of core indicators that could be used as a baseline for measuring a health system’s responsiveness to the needs of older people.

[RESUMEN]. Objetivo. Determinar qué indicadores clave permitirán la medición empírica de la capacidad de respuesta de un sistema de salud a las personas mayores. Métodos. Se llevó a cabo una serie de consultas con expertos para elaborar una lista de indicadores pertinentes. Para elaborar la lista se usó un mapeo conceptual, que incluyó los pasos de preparación, tormenta de ideas y estructuración. Además, se emplearon cuatro países en estudios de casos nacionales para evaluar la viabilidad de medir la capacidad de respuesta del sistema de salud con datos fácilmente disponibles a nivel de país (Barbados, Brasil, Chile y México). Resultados. Se obtuvo una lista de 25 indicadores que se clasificaron como de alta utilidad para la fundamentación de políticas públicas, diez de los cuales también se categorizaron como de alta disponibilidad. Los estudios de casos nacionales fueron útiles para evaluar la viabilidad de medir la capacidad de respuesta del sistema de salud en diferentes entornos. Conclusiones. La capacidad de respuesta se puede evaluar de manera integral a) abordando las características intrínsecas del sistema mediante sus insumos, resultados inmediatos y resultados intermedios, y b) determinando el efecto del sistema en la satisfacción de las necesidades de las personas mayores en cuanto a su salud, protección financiera y expectativas. Es necesario un mayor consenso para elaborar una lista de indicadores centrales que puedan usarse como línea de base para medir la capacidad de respuesta de un sistema de salud ante las necesidades de las personas mayores.

[RESUMO]. Objetivo. Identificar os principais indicadores que permitem medir de forma empírica a resposta de um sistema de saúde às pessoas idosas. Métodos. Realizamos uma série de consultas com especialistas para desenvolver uma lista relevante de indicadores. O mapeamento de conceitos foi utilizado para criar a lista, incluindo as etapas de preparação, discussão de ideias e estruturação. Além disso, quatro países foram usados como estudos de casos nacionais para verificar a viabilidade de medir a capacidade de resposta do sistema de saúde com dados de nível nacional prontamente disponíveis (Barbados, Brasil, Chile e México). Resultados. Nosso estudo resultou em uma lista de 25 indicadores pontuados como de grande utilidade para a informação para políticas públicas, 10 dos quais foram também classificados como de alta disponibilidade. Os estudos de casos nacionais foram úteis para avaliar a viabilidade de medir a capacidade de resposta do sistema de saúde em diferentes meios. Conclusões. A capacidade de resposta pode ser avaliada integralmente por meio de (i) abordagem das características intrínsecas do sistema por meio de seus insumos, resultados e desfechos, e (ii) medição do impacto do sistema na resposta às necessidades das pessoas idosas em termos de saúde, proteção financeira e expectativas. É necessário maior consenso para desenvolver uma lista de indicadores básicos que possam ser usados como linha de base para medir a capacidade de resposta de um sistema de saúde às necessidades das pessoas idosas.

Implementing long-term care systems in the Americas: a regional strategy

[ABSTRACT]. The Region of the Americas is facing accelerated demographic and epidemiological changes. As these trends will continue in future years, long-term care needs are expected to rise. How can countries respond to these challenges?We propose that countries in the Region should invest in the implementation of long-term care systems. Con-sidering the heterogeneity in the Region, we propose a strategy based on three components: (i) understanding the problem; (ii) thinking about solutions; and (iii) building support and consensus. Depending on each coun-try’s needs and capacities, these three elements suggest short-term and long-term actions and goals, from generating better information on long-term care needs to the implementation of long-term care systems. Long-term care is a relevant issue for the Region today. The task is challenging, but countries need to embrace it and move forward before it is too late.

[RESUMEN]. La Región de las Américas está haciendo frente a acelerados cambios demográficos y epidemiológicos. Considerando que estas tendencias se mantendrán en los años venideros, se prevé que la necesidad de cuidados a largo plazo se incrementará. ¿Cómo pueden responder los países a estos retos?Proponemos que los países de la Región inviertan en el establecimiento de sistemas de cuidados a largo plazo. Considerando la heterogeneidad de la Región, proponemos una estrategia fundamentada en tres com-ponentes: a) comprender el problema; b) pensar en soluciones; y c) generar apoyo y consenso. De acuerdo con las necesidades y las capacidades de cada país, estos tres elementos determinan los objetivos y las medidas a corto y largo plazo, desde la producción de mejor información sobre las necesidades de cuidados a largo plazo hasta el establecimiento de sistemas de cuidados a largo plazo.Hoy en día, los cuidados a largo plazo son una cuestión pertinente en la Región. Aunque esta tarea represente un reto, los países deben aceptarlo y progresar antes de que sea demasiado tarde.

[RESUMO]. A Região das Américas encontra-se em transição demográfica e epidemiológica acelerada. Esta tendência deve persistir nos próximos anos e antecipa-se um crescimento da demanda por assistência a longo prazo. Como os países podem enfrentar estes desafios?A nossa proposta é que os países das Américas invistam na implementação de sistemas de assistência a longo prazo. Como a Região se caracteriza pela heterogeneidade entre os países, propomos uma estratégia alicerçada em três componentes: (i) entender o problema, (ii) buscar soluções e (iii) granjear apoio e con-senso. Dependendo das necessidades e da capacidade de cada país, esses três componentes devem servir para estabelecer metas e ações a curto ou longo prazo, que vão desde aprofundar o conhecimento sobre as necessidades existentes a implementar os sistemas em si. A assistência a longo prazo é uma questão atual de interesse para a Região. A tarefa envolve muitos desafios, mas os países precisam encampá-la e avançar antes que seja tarde demais.

Screening for intrinsic capacity impairments as markers of increased risk of frailty and disability in the context of integrated care for older people: Secondary analysis of MAPT.

AIM: This longitudinal secondary analysis of the Multidomain Alzheimer Preventive Trial (MAPT) aimed to test whether the Integrated Care for Older People (ICOPE) Step 1 screening tool is able to identify people at risk of developing frailty and disability in basic (ADL) and instrumental (IADL) activities of daily living among community-dwelling older adults. PARTICIPANTS AND SETTING: Seven hundred and fifty-nine (n = 759) non-demented participants of the MAPT aged 70-89 years were assessed in memory clinics in France between 2008 and 2013. METHODS: We measured six intrinsic capacity (IC) impairments, adapted from the ICOPE screening tool. We used Cox models to estimate the adjusted hazard ratios of incident frailty and IADL/ADL disability. Incident frailty was defined by Fried's phenotype, and incident disability was measured according to Lawton and Katz for IADLs and ADLs. RESULTS: Limited mobility (HR= 2.97, 95%CI= 1.85-4.76), depressive symptoms (HR= 2.07, 95%CI= 1.03-4.19), and visual impairment (HR= 1.70, 95%CI 1.01-2.86) were associated with a higher incidence of frailty over 5 years. Each additional IC condition demonstrated a positive association with a higher risk of incident frailty, IADL, ADL disability, with risk increased by 47%, 27%, and 23% over 5 years, respectively. CONCLUSION: Screening for IC impairments identifies older adults at higher risk of incident frailty and incident IADL/ADL disability. It is relevant to screen for these impairments together because the risk of frailty and disability increases with each additional one. ClinicalTrials.gov identifier: NCT00672685.

What day is today? Cognitive capacity and the risk of incident dementia in the context of integrated care for older people (ICOPE Step 1).

Based on clinical observations, our objective was to test if the older adults who failed to recall the name of the weekday, or had a higher number of mistakes in the word recall were at higher risk of mild cognitive impairment (MCI) or dementia. Longitudinal data of the Multidomain Alzheimer Preventive Trial (MAPT) was used to retrospectively measure the cognitive capacity according to the ICOPE Step 1 tool. Incident dementia was assessed by two multidisciplinary committees independent from each other. MCI was defined as Clinical Dementia Rating scale CDR = 0.5. Failure to recall the name of the weekday had a three-fold risk of incident dementia in the next 5 years (HRa = 3.11, 95%CI: 1.18-8.17). Having two or three mistakes in the word recall carried a higher risk of incident dementia, (HRa for two mistakes = 3.50, 95% CI: 1.49-8.26; HRa for three mistakes = 4.28, 95% CI: 1.60-11.46), but not MCI. People with impaired cognitive capacity according to the ICOPE Step 1 tool deserve further assessment and a closer follow-up.

[Social factors associated with tobacco and alcohol consumption in Mexican adolescents from populations under 100 000 inhabitants.] / Factores sociales asociados con el consumo de tabaco y alcohol en adolescentes mexicanos de poblaciones menores a 100 000 habitantes.

OBJECTIVE: To evaluate the social factors associated with tobacco and alcohol consumption in Mexican adolescents from populations under 100 000 inhabitants. MATERIALS AND METHODS: Cross-sectional study based on the National Health and Nutrition Survey (Ensanut100k). It included adolescents between 10-19 years. Adjusted logistic regression models were estimated, obtaining Odds Ratio (OR) and confidence intervals 95% (CI95%). RESULTS: Prevalence of tobacco consumption in the last month was 5.5% (10-14 years= 1.0%, 15-19 years= 11.2%); alcohol consumption 9.3%, and excessive alcohol consumption, 2.8%. Associated factors: smoking, sex (male, OR=6.00, CI95%: 2.89-12.46), age (OR=1.73, CI95%: 1.46-2.04), remunerated work (OR=2.87, CI95%: 1.12-7.34), affiliation to health services (OR=0.26, CI95%: 0.08-0.82); alcohol consumption, (male, OR=5.11, CI95%: 2.38-11.00), age (OR=1.70, CI95%: 1.51-1.92), remunerated work (OR=2.51, CI95%: 1.01-6.24). CONCLUSIONS: To reduce the consumption of alcohol and tobacco in adolescents, comprehensive prevention strategies must be implemented that consider the individual and social context.

OBJETIVO: Evaluar los factores sociales asociados con el consumo de tabaco y alcohol en adolescentes mexicanos de poblaciones menores a 100 000 habitantes. MATERIAL Y MÉTODOS: Estudio transversal a partir de resultados de la Encuesta Nacional de Salud y Nutrición (Ensanut 100k) que se enfocó en adolescentes de entre 10 y 19 años. Se estimaron modelos de regresión logística ajustados y se obtuvieron razones de momios (RM) e intervalos de confianza al 95% (IC95%). RESULTADOS: La prevalencia de consumo de tabaco en el último mes fue de 5.5% (10-14 años=1.0%, 15-19 años= 11.2%); de consumo de alcohol, 9.3%, y de consumo excesivo de alcohol, 2.8%. Factores asociados: consumo de tabaco, sexo (hombre, RM= 6.00; IC95%: 2.89-12.46), edad (RM=1.73; IC95%: 1.46-2.04), trabajo remunerado (RM= 2.87; IC95%: 1.12-7.34) y afiliación a servicios de salud (RM= 0.26; IC95%: 0.08-0.82); consumo de alcohol, (hombre, RM= 5.11; IC95%: 2.38-11.0), edad (RM= 1.70; IC95%: 1.51-1.92) y trabajo remunerado (RM= 2.51; IC95%: 1.01-6.24). CONCLUSIONES: Para reducir el consumo de alcohol y tabaco en adolescentes deben implementarse estrategias de prevención integrales que tomen en cuenta el contexto individual y social.

Factores sociales asociados con el consumo de tabaco y alcohol en adolescentes mexicanos de poblaciones menores a 100 000 habitantes / Social factors associated with tobacco and alcohol consumption in Mexican adolescents from populations under 100 000 inhabitants

Resumen: Objetivo: Evaluar los factores sociales asociados con el consumo de tabaco y alcohol en adolescentes mexicanos de poblaciones menores a 100 000 habitantes. Material y métodos: Estudio transversal a partir de resultados de la Encuesta Nacional de Salud y Nutrición (Ensanut 100k) que se enfocó en adolescentes de entre 10 y 19 años. Se estimaron modelos de regresión logística ajustados y se obtuvieron razones de momios (RM) e intervalos de confianza al 95% (IC95%). Resultados: La prevalencia de consumo de tabaco en el último mes fue de 5.5% (10-14 años=1.0%, 15-19 años= 11.2%); de consumo de alcohol, 9.3%, y de consumo excesivo de alcohol, 2.8%. Factores asociados: consumo de tabaco, sexo (hombre, RM= 6.00; IC95%: 2.89-12.46), edad (RM=1.73; IC95%: 1.46-2.04), trabajo remunerado (RM= 2.87; IC95%: 1.12-7.34) y afiliación a servicios de salud (RM= 0.26; IC95%: 0.08-0.82); consumo de alcohol, (hombre, RM= 5.11; IC95%: 2.38-11.0), edad (RM= 1.70; IC95%: 1.51-1.92) y trabajo remunerado (RM= 2.51; IC95%: 1.01-6.24). Conclusiones: Para reducir el consumo de alcohol y tabaco en adolescentes deben implementarse estrategias de prevención integrales que tomen en cuenta el contexto individual y social.

Abstract: Objective: To evaluate the social factors associated with tobacco and alcohol consumption in Mexican adolescents from populations under 100 000 inhabitants. Materials and methods: Cross-sectional study based on the National Health and Nutrition Survey (Ensanut100k). It included adolescents between 10-19 years. Adjusted logistic regression models were estimated, obtaining Odds Ratio (OR) and confidence intervals 95% (CI95%). Results: Prevalence of tobacco consumption in the last month was 5.5% (10-14 years= 1.0%, 15-19 years= 11.2%); alcohol consumption 9.3%, and excessive alcohol consumption, 2.8%. Associated factors: smoking, sex (male, OR=6.00, CI95%: 2.89-12.46), age (OR=1.73, CI95%: 1.46-2.04), remunerated work (OR=2.87, CI95%: 1.12-7.34), affiliation to health services (OR=0.26, CI95%: 0.08-0.82); alcohol consumption, (male, OR=5.11, CI95%: 2.38-11.00), age (OR=1.70, CI95%: 1.51-1.92), remunerated work (OR=2.51, CI95%: 1.01-6.24). Conclusions: To reduce the consumption of alcohol and tobacco in adolescents, comprehensive prevention strategies must be implemented that consider the individual and social context.