Identification of intrinsic capacity impairment: diagnostic performance of integrated care for older people (ICOPE) screening tools in Zimbabwe.

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.