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| ID | Type | Description | Link |
|---|---|---|---|
| NICTran2023-0013 | Other Grant/Funding Number | National Medical Research Council |
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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.
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
Step 3: Risk Stratification & Care Planning
Step 4: Intervention & Referral
Step 5: Monitoring & Follow-up
In addition, blood and digital biomarkers will be collected from a subgroup of study participants.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Screen and Prevent Intrinsic Capacity Decline in Elders (SPICE) | Community-dwelling adults robust or pre-frail aged 60 years and above who undergo WHO ICOPE-aligned digital intrinsic capacity screening, structured risk stratification, personalised multidomain community-based interventions, and longitudinal follow-up. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| ICOPE-Based Digital Intrinsic Capacity Monitoring and Triggered Follow-up (SPICE Pathway) | Other | 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:
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| Measure | Description | Time Frame |
|---|---|---|
| Prevalence of intrinsic capacity decline at baseline (robust / pre-frail) | 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). | Baseline |
| Uptake of recommended actions (implementation effectiveness) | 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). | Up to 3 months post-recommendation |
| Measure | Description | Time Frame |
|---|---|---|
| Identification of (a set of) biomarkers of aging | Both blood biomarkers and digital markers associated with various intrinsic capacity | 30 months |
| Feasibility and reach | Proportion of individuals in each community setting complete both Step 1 and Step 2 assessment. |
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Inclusion Criteria:
Exclusion Criteria:
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Recruitment will be conducted from Active Ageing Centre and Community Centres.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Reshma Merchant (Associate Professor), MBChB (Edin) | Contact | +6567724368 | mdcram@nus.edu.sg |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| National University Hospital | Recruiting | Singapore | Singapore |
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| Label | URL |
|---|---|
| Description of the WHO ICOPE Framework | View source |
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It will not be individual level data but rather a group data.
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|
| 30 months |
| Change in intrinsic capacity and function over time | Change in number of impaired IC domains (0-5) from baseline to follow-up. | 12 months from enrolment |
| Frailty progression | Proportion transitioning from robust → pre-frail/frail; pre-frail → frail | over 12 months follow up |
| Cost per participant screened | 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. | 3 years |
| Number of participants with at least one unscheduled emergency department visit or hospital admission | 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. | 12 months |
| Implementation outcomes assessed using RE-AIM framework | 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. | 3 years |
| ID | Term |
|---|---|
| D000073496 | Frailty |
| ID | Term |
|---|---|
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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