Implementation and impact of the World Health Organization integrated care for older people (ICOPE) program in China: a randomised controlled trial.

BACKGROUND: Fragmentation of services increases health and social care burden as people live longer with higher prevalence of diseases, frailty and dependency. Local evidence for implementing person-centred integrated care is urgently needed to advance practice and policies to achieve healthy ageing. OBJECTIVE: To test the feasibility and impact of World Health Organization's (WHO) Integrated Care for Older People (ICOPE) approach in China. DESIGN: A randomised controlled trial examining the feasibility of implementing ICOPE approach, evaluating its impact on health outcomes and health resource utilisation. SETTING: Primary care setting in urban and suburban communities of Chaoyang District, Beijing, China. SUBJECTS: Community-dwelling older adults screened as at-risk of functional declines and randomised into intervention (537) and control (1611) groups between September 2020 and February 2021. METHODS: A 6-month intervention program following WHO's ICOPE care pathways implemented by integrated care managers compared to standard available care. RESULTS: After 1 to 1 propensity score matching, participants in intervention and control groups (totally 938) had comparable baseline characteristics, demonstrated feasibility of implementing ICOPE with satisfaction by participants (97-99%) and providers (92-93%). All outcomes showed improvements after a 6-month intervention, while statistically significant least-squares mean differences (control-intervention) in vitality (Mini-Nutritional Assessment Short Form to measure vitality, -0.21, 95% CI, -0.40-0.02), mobility (Short Physical Performance Battery to measure mobility, -0.29, 95% CI, -0.44-0.14) and psychological health (Geriatric Depression Scale five items to measure psychological health, 0.09, 95% CI, 0.03-0.14) were observed (P < 0.05). CONCLUSIONS: It is feasible to localise and implement WHO's ICOPE approach in regions with fragmented resources such as China. Preliminary evidence supports its acceptance among key stakeholders and impact on health outcomes.

Geographical accessibility of medical resources, health status, and demand of integrated care for older people: a cross-sectional survey from Western China.

BACKGROUND: The World Health Organization (WHO) published the Integrated Care for Older People (ICOPE) framework to help healthcare providers cope with the population aging crisis. However, the relevant evidence on the demands of older people and the compensatory capacity of the environment is limited. This study reports for the first time the level of the ICOPE demand in Western China that includes the impact of geographic accessibility of medical resources (GAMR) on ICOPE demand and the potential mechanism of health status. METHODS: A cross-sectional questionnaire survey was conducted among 1200 adults aged 60 years and older selected through multi-stage stratified cluster sampling to obtain relevant data, including ICOPE demand, health status, and GAMR. Propensity score matching (PSM) was used to analyze the impact of GAMR on ICOPE demand among older people and those with different health statuses. RESULTS: Among the prospective research participants, 1043 were eligible for the study. The mean score of ICOPE demand among all participants was 3.68 (standard deviation [SD] = 0.78). After adjusting for covariates between high and low GAMR groups (1:1 match), ICOPE demand was significantly higher in the low GAMR group than in the high GAMR group (average treatment effect on the treated [ATT] = 0.270, p < 0.05). For both good and poor self-rated health status, the ICOPE demand of the low GAMR group was significantly higher than that in the high GAMR group (ATT = 0.345, p < 0.05; ATT = 0.190, p < 0.05). For chronic diseases, the ICOPE demand of older people with multimorbidity in the low GAMR group was significantly higher than that in the high GAMR group (ATT = 0.318, p < 0.01). CONCLUSIONS: The older population in Western China has a relatively high demand for ICOPE. Low GAMR is a key factor in ICOPE demand growth in this region. It accelerates demand release for both older people with multimorbidity and self-perceptions of health.

Towards a core outcome set (COS) for intrinsic capacity (IC) intervention studies in adults in midlife and beyond: a scoping review to identify frequently used outcomes and measurement tools.

This scoping review was conducted to identify the outcomes and measurement tools used in IC intervention studies, as first step towards the development of a core outcome set (COS) for IC trials. PRISMA-ScR and COS-STAD were followed. The review considered randomized controlled trials targeting IC published in Medline, Scopus, Embase, Cochrane Central Register of Controlled Trials, and clinicaltrials.gov, until June 2023. Of 699 references, 534 studies were screened once duplicates were removed, 15 were assessed for eligibility, and 7 (4 articles and 3 protocols) met eligibility criteria. Twenty-eight outcomes were identified (19 related to IC and its domains and 9 unrelated). The most reported primary outcome was the change in IC levels postintervention (5 over 7 studies) and the most reported outcomes (either as primary and/or secondary) were the changes in physical performance and in depressive symptoms (6 over 7 studies). Fifty-five tools used to construct the domains' z-scores and/or assess the effect of interventions were identified (47 related to IC and its domains and 8 unrelated). The most reported tool was an IC Z-score, calculated by 4 domains' z-scores: locomotor, vitality, cognitive, and psychological (5 over 7 studies). The tools differed among studies (10 locomotor related, 6 vitality related, 16 cognitive related, 8 psychological related, 6 sensorial related, 8 unrelated tools). The vast heterogeneity (28 outcomes and 55 tools within 7 studies) highlighted the need of a COS. These outcomes and tools will be presented to experts in a future step, to select the ones that should be taken into consideration in IC trials.

[ICOPE Evaluations and Promoting Health in Older Adults: A Chinese Medicine Perspective].

The Integrated Care for Old People (ICOPE) guidelines were developed by the World Health Organization. These guidelines address functional abilities in older adults in six intrinsic capacity domains, including cognitive decline, limited mobility, malnutrition, visual impairment, hearing loss, and depressive symptoms with the goal of improving their assessment and management. In this article, aging is interpreted from the perspective of Chinese medicine and guided by the theory of Yin Yang, the five elements, the six ICOPE domains, and the five organs (liver, heart, spleen, lungs, and kidneys). Huang Di Nei Jing's concept of disease prevention is proposed in a manner that corresponds to the three-stage preventive public health strategy for promoting health, delaying the effects of aging, and improving quality of life in older adults.

Diagnostic performance analysis of the Integrated Care for Older People (ICOPE) screening tool for identifying decline in intrinsic capacity.

BACKGROUND: Intrinsic capacity (IC) is a comprehensive indicator of an individual's positive attributes. The World Health Organization (WHO) recommends a two-step approach to assess IC decline among older people. The first step involves the used of the integrated care for older people (ICOPE) screening tool to identify potential issues, and the second step involves using detailed assessments for confirmation. This study aimed to assess the diagnostic performance of the ICOPE screening tool as a simple preliminary screening to identify IC decline among community-dwelling older people, which has been rarely reported in China. METHODS: This cross-sectional study included 228 community-dwelling older individuals aged ≥ 75 (mean age, 84.0 ± 4.4 years; 131 [57.5%] females) who completed the IC evaluation according to the WHO IC assessment pathway. The diagnostic performance of the ICOPE screening tool was calculated using a 2 × 2 table and a receiver operating characteristic curve. RESULTS: The proportion of possible IC decline identified by the ICOPE screening tool was 79.4%, whereas the actual IC decline assessed by the detailed assessment was 73.2%, mainly in locomotion. The ICOPE screening tool showed sensitivity and specificity of 94.6% and 62.3%, respectively, with an overall diagnostic accuracy of 86.0%. The diagnostic effectiveness of the ICOPE screening tool was 0.91 (95% confidence interval: 0.87-0.95, p = 0.020). Except for the sensory dimension, the sensitivity of the ICOPE screening tool for diagnosing impairments in each dimension of the IC was the highest in the cognition domain (100%) and the lowest in the vitality domain (51.3%), whereas the specificity was the highest in vitality (94.7%) and the lowest in cognition (55.6%). CONCLUSIONS: The ICOPE screening tool exhibits high sensitivity and can be used as an IC screening tool in community-dwelling older people. However, further improvements are needed in the vitality dimension of the ICOPE screening tool to enhance its sensitivity in identifying individuals at risk of malnutrition.

Identification of decreased intrinsic capacity: Performance of diagnostic measures of the ICOPE Screening tool in community dwelling older people in the VIMCI study.

BACKGROUND: The World Health Organization (WHO) has developed the Integrated Care for Older People (ICOPE) strategy to face the challenges of ageing societies. This strategy is focused on person centered care and the assessment intrinsic capacity (IC). Early identification of five domains of IC (cognition, locomotion, vitality, sensory (hearing and vision), and psychological) has been shown to be related with adverse outcomes and can guide actions towards primary prevention and healthy ageing. IC assessment proposed by the WHO ICOPE guidelines is composed by two steps: First, Screening for decreased IC by the ICOPE Screening tool; second, by the reference standard methods. The aim was to assess the performance of diagnostic measures (sensibility, specificity, diagnostic accuracy, and agreement of the ICOPE Screening tool) compared to the reference standard methods in European community-dwelling older adults. METHODS: Cross-sectional analysis of the baseline of the ongoing VIMCI (Validity of an Instrument to Measure Intrinsic Capacity) cohort study, which was carried out in Primary Care centers and outpatient clinics from 5 rural and urban territories in Catalonia (Spain). Participants were 207community dwelling persons ≥ 70-year-old with Barthel ≥ 90, without dementia or advanced chronic conditions who provided their consent to participate. The 5 IC domains were assessed by the ICOPE Screening tool and the reference methods (SPPB, gait speed, MNA, Snellen chart, audiometry, MMSE, GDS5) during patients' visit. Agreement was assessed with the Gwet AC1 index. RESULTS: ICOPE Screening tool sensitivity was higher for cognition (0.889) and ranged between 0.438 and 0.569 for most domains. Specificity ranged from 0.682 to 0.96, diagnostic accuracy from 0.627 to 0.879, Youden index from 0.12 to 0.619, and Gwet AC1 from 0.275 to 0.842. CONCLUSION: The ICOPE screening tool showed fair performance of diagnostic measures; it was helpful to identify those participants with satisfactory IC and showed a modest ability to identify decreased IC in older people with high degree of autonomy. Since low sensitivities were found, a process of external validation would be recommended to reach better discrimination. Further studies about the ICOPE Screening tool and its performance of diagnostic measures in different populations are urgently required.

Intrinsic capacity and 5-year late-life functional ability trajectories of Chinese older population using ICOPE tool: the Rugao Longevity and Ageing Study.

BACKGROUND AND AIMS: Knowledge of how intrinsic capacity (IC) shape functional ability (FA) trajectories in later life remains unclear. We investigated the changes in IC and their impact on 5-years FA trajectories in the Chinese older population. METHODS: A total of 1640 older adults from the Rugao Longitudinal Ageing Study were included and analyzed. FA was assessed by The Lawton Instrumental Activities of Daily Living Scale (IADLs). We used cognition, psychology, locomotion, sensory capacity, and vitality to capture the multiple domains of IC according to the ICOPE method. The IC was derived retrospectively from variables collected before this was described by WHO. RESULTS: At baseline, a higher IC was associated with higher IADLs (ß = 0.98, 95% CI 0.90, 1.06, P < 0.001). Individuals with declines in IC between wave1 and wave2 experienced a faster decline in IADLs over time (ß = - 0.28, 95% CI - 0.40, - 0.16, P < 0.001) after considering covariates. One or more impairment IC scores at baseline strongly predicted death (HR = 1.20, 95% CI 1.11, 1.30, P < 0.001). In addition, according to the IC scores at baseline, we stratify IC in low, middle, and high, compared with those in the high IC score, those in the low were associated with a 2.56-fold (95% CI 1.64, 4.01, P < 0.001) higher risk of mortality, after adjustment for variables. CONCLUSION: Changes in IC shape FA trajectories. IC impairment is associated with an increased risk of death. Assessing intrinsic capacity would facilitate early identification of older adults at high risk of adverse outcomes and prompt targeted interventions.

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.

[Tele-nursing: an innovation in geriatrics]. / Le télésuivi infirmier, une innovation en gériatrie.

The World Health organization programme Integrated Care for Older People involves the long-term monitoring of the many senior citizens who are registered. It is made possible by tele-nursing, but requires new skills for the nursing who implement it.

[Content and application of Icope step 2: feedback from nurses]. / Contenu et application du step 2 d'Icope, retour d'expérience des infirmières.

With the ICOPE programme, the nurses received specific, theoretical and practical, training, that enabled them to broaden their field of competence. This approach has enabled them to expand and consolidate professional cooperation networks and to consolidate their, crucial, position in prevention in the broad sense of the term with the elderly. The aim of the Icope programme is to offer long-term monitoring of the senior citizen, as part of his or her life project.

[Full support from step 1 to step 5]. / La prise en charge complète du step 1 au step 5.

Comprehensive care from step 1 to step 5 of Integrated Care for Older People programme requires the implementation of a new care pathway. It has to take into account the resources of each territory and to be oriented towards maintaining the capacities of older people.

[Step 1 screening: experimentation in Occitania with nurses and pharmacists]. / Le dépistage step 1 : expérimentation en Occitanie avec les infirmiers et les pharmaciens.

Screening with the step 1 tool is the principal modality of entry into the ICOPE program. This preliminary step is particularly an initiative of primary care health professionals, who are daily caring older people. In Occitania, as part of the deployment of ICOPE program, nurses and pharmacists, were invited to integrate the step 1 in their practices. They benefited, if they wished, from a free webinar training.

[Step 1 screening: experimentation in Occitania with nurses and pharmacists]. / Icope : pour aider les professionnels de santé à prévenir la dépendance chez les seniors.

The ICOPE program proposed by the WHO to reduce the number of dependent subjects is composed of 5 steps that can be carried out in primary care: screening, integrated assessment, personalized care plan, monitoring of the plan care, community involvement and support for caregivers. The target population is independent seniors aged 60 years and over. Digital tools have been developed to facilitate the assessment and follow-up of the subjects included in this care project.

Predictive Validity of Intrinsic Capacity Composite Scores for Risk of Frailty at 2 Years: A Comparison of 4 Scales.

OBJECTIVE: Intrinsic capacity (IC) and frailty are complementary constructs that encapsulate functional capacities of older adults. Although earlier studies suggest the utility of composite IC scores in predicting risk of frailty, key gaps remain with the lack of direct comparative studies between different IC scales and lack of a composite score based on the World Health Organization Integrated Care for Older People (ICOPE) tool. We aimed to compare different IC scales, including an ICOPE-based scale, in their predictive ability for risk of frailty at 2 years in healthy community-dwelling older adults. DESIGN: Cohort study. SETTING AND PARTICIPANTS: A total of 230 participants (age: 67.2 ± 7.4 years) from the GeriLABS-2 cohort study. METHODS: We derived composite scores by summing 4 IC domains (locomotion, cognition, vitality, and psychological). We compared composite scores of 4 scales: IC1-Chew 2021, range: 0-8; IC2-Liu 2021, range: 0-4; IC3-ICOPE, range: 0-4; IC4-modified ICOPE, range: 0-8. The primary outcome was risk of frailty using the modified Fried Frailty Phenotype. We performed logistic regression to examine the association of baseline composite IC with risk of frailty. We also examined the impact of individual domains and number of impaired domains on risk of frailty. RESULTS: Among 193 (83.9%) older adults who completed 2-year follow-up, 20 (10.4%) met criteria for risk of frailty. When adjusted for covariates, 2-point per domain scales (IC1/IC4) predicted increased risk of frailty (OR, 4.31; 95% CI, 1.55-11.96; OR, 5.00; 95% CI, 1.75-14.26). When further adjusted for baseline frailty, only IC4 remained significant (OR, 4.28; 95% CI, 1.45-12.60). Among the domains, impaired locomotion and vitality were associated with risk of frailty. Greater number of impaired domains predicted increased risk of frailty (IC1/IC2: ß = 0.18-0.19, P < .05). CONCLUSIONS AND IMPLICATIONS: Baseline composite IC score using 2-point per domain scales better predicted risk of frailty at 2 years, predicated on impaired locomotion/vitality and greater number of impaired domains. For early identification of healthy older adults at risk of frailty, an ICOPE-based scale should be considered, as it is effective and accessible.

Intrinsic capacity assessment using World Health Organization Integrated Care for Older People Step 1, and the association with frailty in community dwelling older adults.

AIM: This study aimed to investigate the association between intrinsic capacity (IC) and frailty in community-dwelling older adults. Specifically, we examined the utility of the World Health Organization's Integrated Care for Older People Step 1 screen for identifying frail older persons in the community. METHODS: This is a cross-sectional analysis of a community frailty screening initiative. IC loss was ascertained using the World Health Organization's Integrated Care for Older People Step 1 questions. The Clinical Frailty Scale was used to categorize participants as robust (Clinical Frailty Scale S1-3) or frail (Clinical Frailty Scale ≥4). Logistic regression was used to analyze the association of individual and cumulative IC losses with frailty, adjusting for confounders. Additionally, the diagnostic performance of using cumulative IC losses to identify frailty was assessed. RESULTS: This study included 1164 participants (28.2% frail). Loss in locomotion (adjusted odds ratio [AOR] 1.47, 95% CI 1.07-2.02), vitality (AOR 1.58, 95% CI 1.04-2.39), sensory (AOR 1.99, 95% CI 1.51-2.64) and psychological capacities (AOR 1.92, 95% CI 1.45-2.56) were significantly associated with frailty. Loss in more than three IC domains was associated with frailty. Using loss in at least three ICs identifies frailty, with sensitivity of 38.6%, specificity of 83.5% and positive predictive value of 47.4%. Using loss in at least four ICs improved specificity to 96.9%, and is associated with the highest positive predictive value of 57.6% and highest positive likelihood ratio of 3.55 for frailty among all cut-off values. The area under the receiver operating characteristic curve was 0.64 (95% CI 0.61-0.68). CONCLUSIONS: IC loss as identified through World Health Organization's Integrated Care for Older People Step 1 is associated with frailty community-dwelling older adults. Geriatr Gerontol Int 2024; 24: 457-463.

The icope Intrinsic Capacity Screening Tool: Measurement Structure and Predictive Validity of Dependence and Hospitalization.

OBJECTIVES: To evaluate the measurement structure of the ICOPE screening tool (IST) of intrinsic capacity and to find out whether the IST as a global measure adds explanatory power over and above its domains in isolation to predict the occurrence of adverse health outcomes such as dependence and hospitalization in community-dwelling older people. DESIGN: Secondary analysis of a cohort study, the Toledo Study of Healthy Ageing. SETTING: Province of Toledo, Spain. PARTICIPANTS: Community-dwelling older people. MEASUREMENTS: Items equal or similar to those of the IST were introduced as a reflective-formative construct in a Structural Equation Model to evaluate its measurement structure and its association with dependence for basic and instrumental activities and hospitalization over a three-year period. RESULTS: A total of 1032 individuals were analyzed. Mean age was 73.5 years (sd 5.4). The least preserved indicators were ability to recall three words (18%) and to perform chair stands (54%). Vision and hearing items did not form a single sensory domain, so six domains were considered. Several cognition items did not show sufficiently strong and univocal associations with the domain. After pruning the ill-behaved items, the measurement model fit was excellent (Satorra-Bentler scaled chi-square: 10.3, degrees of freedom: 11, p=0.501; CFI: 1.000; RMSEA: 0.000, 90% CI: 0.000-0.031, p value RMSEA<=0.05: 1; SRMR: 0.055). In the structural model, the cognition domain items were not associated as expected with age (p values 0.158 and 0.293), education (p values 0.190 and 0.432) and dependence (p values 0.654 and 0.813). The IST included as a composite in a model with the individual domains showed no statistically significant associations with any of the outcomes (dependence for basic activities: 0.162, p=0.167; instrumental: -0.052, p=0.546; hospitalization: 0.145, p=0.167), while only the mobility domain did so for dependence (basic: -0.266, p=0.005; instrumental: -0.138, p=0.019). The model fit of the last version was good (Satorra-Bentler scaled chi-square: 52.1, degrees of freedom: 52, p=0.469; CFI: 1.000; TLI: 1.000; RMSEA: 0.01, 90% CI: 0.000-0.02, p value RMSEA<=0.05: 1; SRMR: 0.071). The IST operationalized as the sum of non-impaired domains was not associated after covariate adjustment (dependence for basic activities: -0.065, p=0.356; instrumental: -0.08, p=0.05; hospitalization: -0.003, p=0.949) either. CONCLUSION: The cognitive domain of the IST, and probably other of its items, may need a reformulation. A global measure of intrinsic capacity such as the IST does not add explanatory power to the individual domains that constitute it. So far, our results confirm the importance of checking the findings of the IST with a second confirmatory step, as described in the WHO's ICOPE strategy.

Assessing the Readiness for Implementing the World Health Organization's ICOPE Approach in Hong Kong: Perspectives from Social Care and Policy Stakeholders.

Although integrated care has been considered a key strategy in reforming health systems around the world, it seems hard to realise in practice, particularly in the part of medical social integration. Worse still, little is known about the capacity of social care professionals who implement it, or their perceived roles and responsibilities, as well as the barriers and facilitators that stakeholders from the health and social sectors identify as factors affecting the ICOPE implementation process. Therefore, the present study was performed to probe into these issues. Data were collected from an online survey based on the WHO ICOPE scorecard (N = 34), and focus groups with policy makers, managers, health and social care professionals (N = 47). Inductive analyses were performed in accordance with the service and system levels within the WHO ICOPE implementation framework. While the findings from the scorecard survey highlight the gap in actualizing the ICOPE approach within the existing social services and care structures, we found support for a model of integrated care underpinned by the WHO ICOPE approach. Factors that may hinder and facilitate ICOPE implementation include workforce capacity-building, coordinated networks and partnerships, and financial mechanisms. This finding can help inform subsequent actions that further support health and social care advancement and collaboration, and the implementation of the ICOPE approach.

Moving towards the ICOPE Approach: Evaluation of Community-Based Intervention Activities on Improving Intrinsic Capacity.

OBJECTIVES: Different types of community-based intervention activities may have differential effects in improving the intrinsic capacity (IC) of older people. This study aims to (i) identify subgroups of older people based on their IC impairments, (ii) examine the differential associations between different types of activity participations and change in IC across subgroups, and (iii) assess whether the activity participation patterns of older people align with the way that would benefit them the most. METHODS: Participants were community-dwelling older people aged 60 years or above. They were screened for IC impairments at baseline, and their participation records of different types (cognitive, physical, nutritional, mental, and social) of intervention activities were collected for one year. An aggregated IC score was created based on four IC domains including cognitive (self-rated memory), locomotor (self-rated difficulties in walking), vitality (self-rated weight loss), and psychological (subjective well-being). Cluster analysis was used to group homogenous participants. Mixed-effects regression was used to examine the associations between activity counts (i.e., number of sessions participated) and change in IC. Activity participation patterns were also compared across subgroups. RESULTS: Data were obtained from 7,357 participants (mean age = 74.72 years). Four clusters were identified, including those who were relatively robust (cluster 1, N = 4,380, 59.5%), those who had cognitive decline (cluster 2, N = 2,134, 29.0%), those who had impaired mobility and vitality (cluster 3, N = 319, 4.3%), and those with poor psychological well-being (cluster 4, N = 524, 7.1%). Overall, activity count was associated with IC improvement (ß = 0.073, 95% CI [0.037, 0.108]). However, as regards the cluster-specific results, different types of activities were associated with IC improvement for different specific clusters. For instance, cognitive activity count was associated with IC improvement only for cluster 2 (ß = 0.491, 95% CI [0.258, 0.732]). Notably, none of the activity types were associated with IC improvement for cluster 1. Regarding the activity participation patterns, there were no significant differences across the four clusters (Wilk's Λ = 0.997, F = 1.400, p = .138). CONCLUSIONS AND IMPLICATIONS: IC improvement depended on the activity types and IC status of older people. In view of this, a people-centred and targeted approach should be adopted to maximize the overall benefits of intervention activities.