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Background: APOE ε4/ε4 genotype increases the risk of Amyloid-Related Imaging Abnormalities (ARIA) from anti-amyloid antibody treatment (AAT). While guidelines recommend testing, its practical utility depends on the resulting probability (p) that treatment is actually withheld for ε4-homozygotes, which varies significantly across clinical settings.

Objectives: To quantify the Number Needed to Test (NNT) to prevent one ARIA event as a function of p of withholding AAT in ε4/ε4 patients.

Design: A Bayesian simulation study using a Beta-Binomial model to analyze genotype-stratified contingency tables.

Setting: Data were derived from two published, phase 3 clinical trials: Clarity-AD (lecanemab) and TRAILBLAZER-ALZ 2 (donanemab).

Participants: Aggregate data from source trials.

Intervention: Simulation of varying treatment discontinuation probability p from 0 (none) to 1 (universal for ε4-homozygotes).

Measurements: NNT to prevent one ARIA event (any ARIA-E, any ARIA-H, and symptomatic ARIA-E) and the fractional reduction in total ARIA events as a function of p.

Results: NNTs increased (worsened) significantly as p decreased. Under the most conservative policy (p = 1), the median NNT to prevent one any ARIA-E event was 20-30 (lecanemab) and 15-25 (donanemab), yet this only reduced total ARIA events by 10-30%. The NNT to prevent one symptomatic ARIA-E (lecanemab) was substantially higher, at 70-90 (at p = 1).

Conclusions: The direct safety impact of APOE testing for ARIA mitigation is limited, even under universal discontinuation policies. Its primary value lies in supporting shared decision-making and operational planning rather than as a standalone safety lever.

Background: Subjective memory complaints (SMC) are associated with increased risk of cognitive decline and dementia. SMCs are also influenced by mood and anxiety symptoms, which increased among older adults during the COVID-19 pandemic.

Objective: We investigated whether a single-item SMC measure predicts one-year cognitive decline and whether this predictive relationship remained stable during the early COVID-19 period (2020).

Methods: We analyzed longitudinal data (2011-2023) from the National Health And Aging Trends Study (NHATS), an annual survey of Medicare beneficiaries in the United States. Mixed-effects models assessed the association between self-perceived memory worsening and next-year cognitive outcomes, and tested whether this association differed in 2020.

Results: A total of 33,244 observations from 6676 elderly individuals were included. Higher age, male sex, non-white race, education at or below high school level, lower scores on basic and instrumental activities of daily living, poorer social activity, anxiety symptoms, lower annual income, and self-perceived memory decline each predicted worse cognitive function one year later. However, the interaction between self-perceived memory decline and the COVID-19 pandemic (in 2020) was not significant.

Discussion: A single-item measure of self-perceived memory decline effectively predicts next-year cognitive decline in older adults, independent of the broader social impacts observed during the 2020 COVID-19 pandemic.

Care of older people has evolved from comprehensive geriatric assessment developed in the hospital setting in the UK and USA, to using frailty as a summary indicator, and shifting care to the community following the World Health Organization's definition of healthy ageing using intrinsic capacity (IC) as an indicator. While the concept of IC and implementation of its measurement through the Integrated Care for Older People (ICOPE) model is generally accepted, there is wide variation in uptake into policy. The rate of population ageing, the existence of well-established health and social care systems for older people, and sustainability of healthcare financing through government, social insurance, or out-of-pocket mechanisms, may account for variation in uptake. Initiatives in incorporating ICOPE in Hong Kong and Malaysia are described as illustrations. ICOPE implementation would likely be facilitated by incorporation/adaptation into existing healthcare infrastructure, assisted by trained non-professional care workers or volunteers.

Background: Early diagnosis of Alzheimer's disease and related dementias (AD/ADRD) is critical but often constrained by limited access to fluid and imaging biomarkers, particularly in low-resource settings.

Objective: To develop and evaluate a predictive model for cognitive decline using survey-based data, with attention to model interpretability and fairness.

Methods: Using data from the Mexican Health and Aging Study (MHAS), a nationally representative longitudinal survey of adults aged 50 and older (N = 4095), we developed a machine learning model to predict future cognitive scores. The model was trained on survey data from 2003 to 2012, encompassing demographic, lifestyle, and social determinants of health (SDoH) variables. A stacked ensemble approach combined five base models-Random Forest, LightGBM, XGBoost, Lasso, and K-Nearest Neighbors-with a Ridge regression meta-model.

Results: The model achieved a root-mean-square error (RMSE) of 39.25 (95 % CI: 38.12-40.52), representing 10.2 % of the cognitive score range, on a 20 % held-out test set. Features influencing predictions, included education level, age, reading behavior, floor material, mother's education level, social activity frequency, the interaction between the number of living children and age, and overall engagement in activities. Fairness analyses revealed model biases in underrepresented subgroups within the dataset, such as individuals with 7-9 years of education.

Discussion: These findings highlight the potential of using accessible, low-cost SDoH survey data for predicting risk of cognitive decline in aging populations. They also underscore the importance of incorporating fairness metrics into predictive modeling pipelines to ensure equitable performance across diverse groups.

Introduction: The World Health Organization (WHO) Integrated Care for Older People (ICOPE) framework proposes screening (Step-1) and subsequent in-depth assessment (Step-2) to inform personalised interventions to promote intrinsic capacity (IC) in older adults. We aimed to assess the diagnostic performance of screening approaches against in-depth assessments in Zimbabwe.

Methods: This cross-sectional study recruited older adults age ≥65 years in urban Zimbabwe. For both Steps 1 and 2, IC was assessed using WHO ICOPE-proposed and/or alternative assessments for seven domains: cognition, locomotion, vitality, vision, hearing, psychological, and urinary continence. Diagnostic performance of screening approaches was assessed using metrics, including sensitivity and specificity categorised as good (≥0.80), fair (≥0.50-0.79), poor (<0.50).

Results: The 763 adults were mean (standard deviation) age 74.5(7.2) years: 62.9 % female. Frequencies of IC impairments ranged from 18.1 % for hearing to 92.0 % for vision based on screening, and 13.4 % for urinary incontinence to 62.9 % for vision based on in-depth assessments. Performance of 37 different screening approaches and in-depth assessment comparisons were tested. Of the eight screening approaches with the best performance, sensitivity ranged from good (n = 7) to fair (n = 1), while five had fair and three had poor specificity. Sensitivity of screening approaches ranged from 0.65 (95 %CI: 0.58-0.71) for hearing to 0.93 (95 % CI: 0.89-0.96) for locomotion. Specificity ranged from 0.28 (0.22-0.33) for vision to 0.69 (0.65-0.73) for hearing.

Conclusion: Each domain had a screening approach with good or fair sensitivity and mostly fair specificity, supporting use in ICOPE implementation in Zimbabwe, which is urgently needed given the high prevalence of IC impairments.

Background: The ageing of people living with HIV (PWH) presents unique clinical and public health challenges that are not fully addressed by current care models.

Objective: This Perspective paper aims to explore the feasibility and added value of introducing the World Health Organization (WHO) Integrated Care for Older People (ICOPE) framework and guidelines into HIV care models, using the lens of intrinsic capacity (IC) and functional ability to reframe how age-related conditions are managed. In particular, we discuss how HIV services can adopt intrinsic capacity (IC) assessments and function-centered care as a scalable strategy to promote healthy ageing.

Methods: This is a narrative and conceptual Perspective based on literature review, expert consultation, and clinical case examples, including the Modena HIV Metabolic Clinic and experiences from resource-limited settings.

Results: The ICOPE approach offers a feasible, person-centred framework for identifying and managing early declines of IC across six domains. ICOPE facilitates timely interventions at the primary health care level. HIV care services and systems, already oriented towards longitudinal and multidisciplinary management, are uniquely positioned to pioneer ICOPE implementation.

Conclusion: HIV medicine may serve as a model for expanding the integration of the ICOPE approach across chronic diseases, especially in low-resource settings where primary care structures must address age-related vulnerability. Adopting ICOPE can promote healthy ageing in PWH and beyond.

Background: Frailty represents a significant public health challenge among aging populations. Early and accurate detection is vital for implementing timely interventions that may delay or prevent functional deterioration. Among the available assessment tools, The Fried frailty phenotype is widely recognized as a reference framework for assessing frailty. In parallel, the WHO's ICOPE Step 1 has been developed as a tool to detect potential declines in intrinsic capacity. Considering its design and purpose, ICOPE Step 1 may be regarded as a feasible option for use as a screening tool in clinical and community settings; however, direct comparative analyses within the same population remain limited. This study aimed to evaluate the concordance between the ICOPE Step 1 tool and Fried criteria to inform and enhance frailty screening practices in both clinical and community-based settings.

Methods: This cross-sectional study included 202 community-dwelling older adults aged ≥60 years (mean age 85.0 ± 4.5; 160 [79.2 %] females), categorized as non-frail, pre-frail, or frail based on Fried's frailty phenotype and the WHO ICOPE Step 1 screening tool. The diagnostic performance of the ICOPE tool was assessed in comparison to Fried's criteria by calculating sensitivity, specificity, and the area under the receiver operating characteristic (ROC) curve.

Results: Compared to the reference Fried criteria, the ICOPE Step 1 tool identified a higher proportion of individuals as frail (63 % vs. 29 %) and fewer as robust (2 % vs. 18 %). Diagnostic performance analysis showed a sensitivity of 83.9 % and a specificity of 43.8 %, with an area under the ROC curve (AUC) of 0.639, indicating moderate discriminative ability.

Conclusion: ICOPE Step 1 demonstrated high sensitivity as a rapid, community-based screening tool for identifying older adults at risk of frailty. While it cannot replace the diagnostic utility of the Fried phenotype due to its limited specificity, it serves as a valuable first-line instrument to guide further comprehensive geriatric assessment, particularly via ICOPE Step 2.

The New Mexico Health Care Authority, the University of New Mexico Hospital, and the School of Medicine partnered in 2024 to implement the World Health Organization's Independent Care for Older People (ICOPE) program. The program's mission is to "empower New Mexico's seniors through prevention and person-centered care, enhancing health, independence, and quality of life by improving services, resources, and community support for healthy aging." Using the 2025 second edition of the ICOPE manual, the New Mexico ICOPE team has developed a strategic plan, an organizational structure reliant on community partnerships, a project plan, and algorithms to address the six ICOPE intrinsic capacities, as well as assessments of three key factors including urinary incontinence, social and carer support. The detailed process for algorithm development is described herein. These algorithms are the basis of the smartphone application developed to allow seniors to complete the ICOPE Basic Assessment and significant portions of the In-Depth Assessment at home. The algorithms are designed to enhance the use of community support resources and reduce the need for health care system visits when appropriate, while at the same time integrating primary care services whenever needed. The system architecture and data and information flow are illustrated. The program's evaluation is structured according to the Practical, Robust Implementation and Sustainability Model (PRISM), used to identify the elements of implementation and effectiveness that will be measured. These include contextual factors such as institutional adoption, implementation, and maintenance of ICOPE, the program's reach, and the impact of ICOPE on patient experience of care, population health, and cost of care.

Background: Ageing in Pakistan highlights the urgent need to preserve intrinsic capacity. The WHO Integrated Care for Older People (ICOPE) tool provides a standardized framework for assessing intrinsic capacity. This study applied a translated version of the ICOPE tool in older adults in Karachi to assess intrinsic capacity and its association with sociodemographic and health-related factors.

Methods: A cross-sectional study was conducted among older adults ≥60 years recruited consecutively from a tertiary care setting in Karachi. Intrinsic capacity was assessed using the WHO ICOPE tool, covering cognition, mobility, nutrition, sensory, and psychological well-being. Each domain scored 1 if any item indicated impairment; aggregated scores generated the overall ICOPE score. Sociodemographic and health-related data were collected using a structured questionnaire. Robust linear regression was performed in STATA 17 software. Ethical approval was obtained from the Aga Khan University Ethical Review Committee.

Results: A total of 81 participants (mean age 69.1 ± 3.6 years; 58 % female) were included in the study analysis. Hearing loss (87.7 %), visual impairment (79.0 %), and limited mobility (63.0 %) were the most commonly reported conditions. The mean ICOPE score was 3.4 ± 1.2. Higher scores, reflecting greater impairment and reduced intrinsic capacity, were observed in individuals with hypertension (+0.70 units, 95 % CI: 0.21-1.19) and ischemic heart disease (+0.73 units, 95 % CI: 0.06-1.39).

Conclusion: High rates of impairment across multiple domains of intrinsic capacity were identified among older adults in this setting. The study supports the feasibility of ICOPE in Pakistan and highlights the importance of its wider implementation to facilitate early decline in intrinsic capacity in ageing populations.