The Application Of Integrated Care For Older People Screening Tool In The Measurement Of Intrinsic Capacity In Hospitalized Older Adults

Background:Intrinsic capacity(IC)was defined as the sum of all the individual’s physical and mental capacities that can be used at any time.IC consists of cognitive,locomotion,vitality,sensory and psychology domains,which is closely related to the adverse health outcomes.Early screening for intrinsic capacity in older hospitalized adults may be helpful to provide interventions in the early stage of functional decline,delay or reverse functional decline,and prevent adverse health outcomes.Most existing studies conducted in-depth assessment for those who are in loss of intrinsic capacity,although these tools are accurate in assessment,they have disadvantages such as time and energy consumption,and are difficult to conduct in large-scale assessment.Therefore,it is urgent to explore screening tools suitable to use in clinical settings.The Integrated Care for Older People(ICOPE)screening tool recommended by the World Health Organization has been applied in hospitalized older adults,however,the diagnostic accuracy of the tool in this population has not been reported.Objective:To verify the clinical application effect and diagnostic accuracy of the ICOPE screening tool in hospitalized older adults.Methods:A cross-sectional study was conducted in a tertiary hospital in Beijing from April 2022 to March 2023.255 older hospitalized patients aged 60 years and above were enrolled.Demographic data and health status were collected using self-designed questionnaires.IC screening was performed using the ICOPE screening tool.In the in-depth assessment,cognitive capacity was evaluated by Mini-Mental State Examination(MMSE).Locomotor capacity was evaluated by Short Physical Performance Battery(SPPB).Vitality was evaluated by Short-Form Mini-Nutritional Assessment(MNA-SF).Visual capacity was evaluated by visual acuity,which includes distance vision at 3 m and near vision at 33 cm.Hearing capacity was tested by an app-based hearing audiogram.Psychological capacity was evaluated by Patient Health Questionnaire(PHQ-9).Sensitivity,specificity,Youden Index and diagnostic accuracy were used to evaluate the applicability and diagnostic accuracy of ICOPE screening tool in hospitalized older adults.The factors influencing intrinsic capacity of hospitalized older adults were analyzed by binary logistic regression.Results:The average age of 255 hospitalized older patients was 71.15 ± 6.15 years old.It was found that the highest to lowest rates of impaired intrinsic capacity were hearing,locomotion,vision,vitality,cognition and psychological function.When≥2 functions impairment were taken as the threshold for overall impaired IC in hospitalized older persons,the rate of intrinsic capacity impairment was 61.96%,the sensitivity of ICOPE screening tool was 87.50%,specificity was 60.74%,Youden index was 48.24%,diagnostic accuracy was 73.33%,and the overall diagnostic accuracy was the best.Besides,it was found that age and maximum handgrip strength were factors affecting the intrinsic capacity of hospitalized older adults.Conclusion:The ICOPE screening tool is suitable for hospitalized older patients to use,however,more effective and reliable screening modalities for vision,hearing,and vitality in older patients need to be explored.This study recommends the use of≥2 functions impairment as the threshold of impaired intrinsic capacity in hospitalized older patients.