The integrated care for older people (ICOPE) approach has been developed by the World Health Organization (WHO) in the context of populations around the world ageing rapidly.

This demographic transition will impact on almost all aspects of society and create new and complex challenges for health and social care systems.

Many of these people are likely to experience losses in their health, including developing multi-morbidities, and to live in low- and middle-income settings.

At the same time, the world has united around the United Nations 2030 agenda for sustainable development. This pledges that no one will be left behind and that every human being will have the opportunity to fulfil their potential with dignity and equality.

The sustainable development goals (SDGs) within the 2030 agenda demonstrate a renewed global commitment to reinvigorate and reorganise health systems. This in turn is underpinned by a target for universal health coverage (UHC), whereby all people and communities have access to the quality health services they need without the risk of financial hardship. But unless structural and social adaptations are implemented and quality care is assured, many of the ambitions outlined in the SDGs will not be achieved.

Aligning health systems and services to the needs of older people the WHO World Report on ageing and health and the subsequent global strategy and action plan on ageing and health help to ensure that societal responses to population ageing are aligned with the ambitious 2030 agenda. Both call for action to ensure the needs of older populations are being met by appropriately aligned health and long-term care systems. A transformative approach is needed in the way health systems and the services within them are designed — to ensure care is of high quality, integrated, affordable, accessible and centred on the needs and rights of older people. Integrated care, particularly for older people and people with chronic health conditions, is widely accepted as a mechanism to improve health outcomes and system efficiency.

Building sustainable long-term care systems

WHO defines long-term care as “the activities undertaken by others to ensure that people with significant loss of intrinsic capacity can maintain a level of functional ability consistent with their basic rights, fundamental freedoms and human dignity”.

These activities include social care, health care and the contribution of other sectors, such as transport — and all of these should be integrated to ensure optimal coordination and efficiency. Long-term care systems may include a range of paid and unpaid caregivers, so this needs to be considered in the implementation of the ICOPE approach. WHO proposes the following three strategies to sustainably build long-term care systems.

1) Develop and continually improve the system infrastructure through appropriate legislation and sustainable financing mechanisms that enable access to services.

2) Build capacity in the paid and unpaid workforce by providing training, support and career opportunities.

3) Ensure the quality of social care services. achieving integrated health and social care services and systems for older people needs transformation at the system (macro) level, service level and clinical (micro) level. This guidance for developing systems and services is designed to support the implementation of strategies to achieve ICOPE at the macro and meso levels. Other WHO resources have been developed to support change at the micro level, such as the guidelines on community level-interventions to manage declines in intrinsic capacity and guidance on person-centred assessment and pathways in primary care.

Guiding principles

The ICOPE approach is underpinned by four guiding principles.

1) Older people are afforded the same basic human rights as all people, including the right to the best possible health.

2) Older people should be given equal opportunity to achieve healthy ageing, regardless of social or economic status, place of birth or residence, or social factors.

3)Care should be provided with equality and non-discrimination, particularly on gender, age and ethnicity.

4) Health and social care systems and services need to respond to the unique health and social care needs and goals of older people, which may vary over time, and should address the social determinants of health.

Details of the ICOPE approach to support healthy ageing, health and social care services and

the systems that support them need to respond to the diverse needs of older people, including people with high and stable levels of intrinsic capacity, those experiencing declining intrinsic capacity, and people whose capacity has fallen to the point where they need the care and support of others.

WHO proposed the ICOPE approach to support these diverse needs. This involves health and social care being integrated, and supported by a long-term care system, to better address the needs of older people. The ICOPE approach enables health and long-term care systems — and the services within them — to respond optimally to the unique, varied and often complex needs of older people.

The ultimate aim is to maximise people’s intrinsic capacity and functional ability.

WHO generally considers older people to be in their second half of life, based on the median life expectancy of the population of interest. The ICOPE approach is focused mainly on older people who have declining intrinsic capacity, or who have significant loss in capacity and are care-dependents.

Healthy ageing is the process of developing and maintaining the functional ability that enables well-being in older age. Intrinsic capacity is a person’s total physical and mental reserves.

Functional ability comprises the health-related attributes that enable people to be and to do what they value.

However, the level of care to senior citizens is depend on the resources made by government and private sector in respective countries.

Source: WHO