# Implementation and validation of the WHO ICOPE framework in andorra: a nationwide pilot study

## TL;DR

This study shows how Andorra successfully implemented the WHO ICOPE framework nationwide to improve healthy aging for older adults.

## Contribution

The study demonstrates the feasibility and effectiveness of adapting the WHO ICOPE framework at a national level.

## Key findings

- Local adaptations improved screening accuracy for intrinsic capacity domains like cognition and mood.
- 60% of screen-positives were referred to community-based programs for support.
- The ICOPE model proved scalable and replicable for integrated healthy aging strategies.

## Abstract

•Nationwide implementation of the WHO ICOPE framework in Andorra.•Step 1 screening validated against full Step 2 assessments in 857 older adults.•Local adaptations improved sensitivity and specificity across Intrinsic Capacity domains.•60 % of screen-positives referred to community-based programmes.•Andorra offers a scalable model for integrated healthy ageing strategies.

Nationwide implementation of the WHO ICOPE framework in Andorra.

Step 1 screening validated against full Step 2 assessments in 857 older adults.

Local adaptations improved sensitivity and specificity across Intrinsic Capacity domains.

60 % of screen-positives referred to community-based programmes.

Andorra offers a scalable model for integrated healthy ageing strategies.

Healthy ageing relies on preserving intrinsic capacity (IC), the combination of an individual’s physical and mental capacities. The World Health Organization (WHO) developed the Integrated Care for Older People (ICOPE) framework as a person-centred care pathway to identify declines in IC and link older adults to appropriate interventions. The ICOPE model outlines a four-step approach involving basic community-based assessment, in-depth clinical evaluation, personalized care planning, and regular monitoring. However, evidence on large-scale implementation of this framework remains limited.

To assess the feasibility and diagnostic accuracy of Step 1 screening across all seven municipalities of Andorra, and to link individuals to tailored interventions.

From 2020 to 2025, 874 community-dwelling adults ≥ 60 years underwent Step 1 screening followed by full Step 2 assessment, using instruments from the WHO ICOPE Handbook.

Local adaptations included a clock-drawing test, the Montreal Cognitive Assessment (MoCA), Body Mass Index (BMI), and frequency-based scoring of the Patient Health Questionnaire-9 (PHQ-9). Diagnostic metrics (sensitivity, specificity, and Cohen’s kappa [κ]) were calculated for each domain. Referrals and interventions were tracked.

Of 857 participants analysed, Step 2 showed the highest prevalence of impairment in hearing (55 %) and cognition (39 %). Step 1 sensitivity improved notably after adaptations: cognition (+12 percentage points), mood (+30 percentage points), and nutrition (+6 percentage points), with vision specificity rising from 17 % to 99.5 %. Overall, 1 182 referrals were generated; 8 % joined a 12-week multicomponent programme including physical activity, nutrition and psychosocial support.

The ICOPE model is feasible at national scale. Local adaptations significantly enhanced screening accuracy without added burden. The Andorran experience offers a scalable and replicable model for other countries or regions and highlights the value of embedding healthy ageing in community care.