Frailty, Intrinsic Capacity, Lifestyle
Conditions
Keywords
intrinsic capacity, personalized intervention, frailty, geroscience
Brief summary
This study evaluates the implementation of a structured community-based pathway to screen, risk stratify, and prevent decline in intrinsic capacity (IC) among adults aged 60 years and above in Singapore. Using the World Health Organization (WHO) Integrated Care for Older People (ICOPE) framework and digital screening tools, participants will undergo IC domain screening in community settings. Individuals identified with early decline will receive targeted multidomain interventions and/or referral to primary or specialist care as indicated. Participants will be followed longitudinally to assess feasibility, uptake, functional trajectories, and implementation outcomes.
Detailed description
Population ageing is associated with progressive decline in intrinsic capacity (IC), defined by WHO as the composite of physical and mental capacities across mobility, cognition, vitality (nutrition), psychological, and sensory domains. Early detection of IC decline enables preventive, person-centred interventions to delay frailty, disability, and long-term care dependency. The SPICE study operationalises the WHO ICOPE framework within Singapore's community ageing ecosystem through a coordinated hub-and-spoke model linking:Community screening platforms (e.g., Active Ageing Centres), Community Health Posts, Regional health system services and other social service organisations. The pathway consists of: Step 1: IC Screening * Screening using WHO ICOPE Monitor tools. Step 2: In-Depth Assessment * Participants screening positive for decline undergo structured assessment of affected domains. Step 3: Risk Stratification & Care Planning * Traffic-light classification (low, moderate, high risk) with personalised care plans. Step 4: Intervention & Referral * Multidomain community interventions (exercise, nutrition, cognitive stimulation, psychosocial engagement) or escalation to medical services when required. Step 5: Monitoring & Follow-up * Longitudinal follow-up with repeat IC assessments at defined intervals. The study will evaluate implementation feasibility, prevalence of IC decline, adherence to care pathways, functional outcomes, and cost-effectiveness within a real-world community system. In addition, blood and digital biomarkers will be collected from a subgroup of study participants.
Interventions
OTHERICOPE-Based Digital Intrinsic Capacity Monitoring and Triggered Follow-up (SPICE Pathway)
Participants will undergo baseline intrinsic capacity (IC) screening using WHO ICOPE-aligned tools in community settings. Follow-up contacts/visits will occur over the study period and include: 1. Scheduled follow-up at predefined intervals (e.g., every 3, 6-12 months) for repeat IC assessment and outcome data collection; and 2. Triggered (non-scheduled) follow-up that is initiated when remote/digital monitoring indicates decline in one or more IC domains, poor adherence, or when major intercurrent clinical events are reported/identified, prompting in-depth assessment, care plan adjustment, and referral to Community Health Posts, primary care, or specialist services as appropriate.
Sponsors
National University Hospital, Singapore
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* pre-frail or robust older adults who can provide consent and follow instructions
Exclusion criteria
* frail or with terminal illness
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Prevalence of intrinsic capacity decline at baseline (robust / pre-frail) | Baseline | Proportion of participants (restricted to robust and pre-frail at baseline) with ≥1 impaired IC domain on screening; and proportion impaired by each domain (mobility, cognition, vitality, psychological, sensory). |
| Uptake of recommended actions (implementation effectiveness) | Up to 3 months post-recommendation | Proportion of participants who initiate at least one recommended action within a defined window after screening/plan (e.g., enrolment in a prescribed community programme, completion of recommended assessment, or attendance at a referred service). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Identification of (a set of) biomarkers of aging | 30 months | Both blood biomarkers and digital markers associated with various intrinsic capacity |
| Feasibility and reach | 30 months | Proportion of individuals in each community setting complete both Step 1 and Step 2 assessment. |
| Change in intrinsic capacity and function over time | 12 months from enrolment | Change in number of impaired IC domains (0-5) from baseline to follow-up. |
| Frailty progression | over 12 months follow up | Proportion transitioning from robust → pre-frail/frail; pre-frail → frail |
| Cost per participant screened | 3 years | Programme delivery cost from the provider/programme perspective, calculated as total programme delivery cost divided by the number of participants screened; costs include personnel, training, digital platform/monitoring, screening and assessment delivery, and intervention coordination. |
| Number of participants with at least one unscheduled emergency department visit or hospital admission | 12 months | Number and proportion of participants with at least one unscheduled emergency department visit or unplanned hospital admission during follow-up, based on participant report and/or clinical records where available. |
| Implementation outcomes assessed using RE-AIM framework | 3 years | Reach: Proportion of eligible older adults screened, characteristics of participants. Effectiveness: Proportion of participants with identified IC impairment who receive recommended follow-up actions, including referral to community services, primary care, or multidisciplinary assessment. Adoption: Provider-reported acceptability and perceived usefulness of the screening pathway (measured using an adapted 8-item questionnaire based on the Theoretical Framework of Acceptability (TFA)). Implementation: Adherence to screening protocols among providers, completion of Step 1 and Step 2 assessments, and referral processes. Implementation strategies, barriers, and facilitators will also be documented by qualitative method. Maintenance: Continued delivery of IC screening at participating sites, and Integration of the programme into routine community health services. The 23-item Normalization Measure Development questionnaire (NoMAD) and the 12-item SCIROCCO tool will be used. |
Countries
Singapore
Contacts
CONTACTReshma Merchant (Associate Professor), MBChB (Edin)
Outcome results
None listed