The goal of this intervention study is to screen and identify frailty and decline in intrinsic capacity (physical and mental capacities) in community-dwelling older adults in Singapore, and to evaluate whether early identification and targeted interventions can improve health outcomes and support healthy ageing. The main questions it aims to answer are:
* Can combined frailty and intrinsic capacity screening with targeted interventions prevent or reduce functional decline in older adults, as measured by changes in life space mobility? * Will at least 80% of screened older adults adhere to recommended care pathways and interventions? * Can this screening and intervention programme demonstrate sustainability through continued community participation and recruitment of new partner organizations beyond the initial implementation phase? The investigators will compare an intervention group (receiving immediate assessment and clinical referrals based on identified needs) to a wait-list control group (receiving the same interventions 12 months later) to see if early intervention leads to better health outcomes and quality of life.
Participants will:
* Attend 4 study visits over 2 years (at 6-monthly intervals in the first year, with final assessment at end of year 2), each lasting up to 2 hours. * Undergo comprehensive screening assessments including mobility, cognition, mental health, hearing, vision, and nutritional status. * Receive 2 follow-up phone calls at 3-month and 9-month intervals to monitor progress. * If in the intervention group: receive personalized referrals for further care (which may include comprehensive geriatric assessment, primary care reviews, rehabilitation, or dietitian consultations) and guidance on using a mobile health monitoring application. * If in the wait-list control group: receive the same interventions after their 3rd study visit (12 months later).
Any Singaporean or Permanent Resident (PR) aged 60 years and above
Able to provide informed consent (or legally acceptable representative available)
Non-Singaporeans or non-PRs under 60 years of age
Residents of sheltered or nursing homes
Crossover
INFINITY-ICOPE programme
Other interventionThe INFINITY-ICOPE programme will involve (i) integrated frailty and intrinsic capacity screening, (ii) referral to comprehensive geriatric assessment for frail participants or pathways adapted from the WHO-ICOPE approach for non-frail seniors with intrinsic capacity decline, (iii) 6-monthly self-monitoring for IC and frailty supported through the ENGAGE app and SCREENii.
Life space mobility
To maintain functional independence in older adults, represented by life space mobility (LSM). LSM will be assessed using the University of Alabama Life Space Assessment (LSA) questionnaire. This tool measures the extent of an older adult's movement within their environment, reflecting their community participation and functional independence. The outcome will be expressed as the LSM score, a numerical value derived from the LSA questionnaire, indicating the spatial extent and frequency of movement over the last 4 weeks.
Community implementation outcomes of INFINITY-ICOPE programme
Fidelity: Measured by adherence rates (%) to protocol specifications and intervention delivery as intended, assessed through structured fidelity checklists completed by implementation staff. Penetration: Measured as the proportion (%) of eligible older adults reached and enrolled from target community settings, based on programme enrollment records. Sustainability: Measured by the continued operation of the programme and ongoing partner engagement, assessed through documentation of programme activities and partner participation rates (%) beyond the initial implementation period. Follow-up telephone interviews will be conducted at 3 and 9 months post-enrollment to assess participants' self-reported adherence using a standardized questionnaire. Pre- and post-screening surveys with community and primary care providers will evaluate their experience with the INFINITY-ICOPE programme through Likert-scale items, informing programme refinements.
Adherence to automated frailty screening and remote intrinsic capacity monitoring
Proportion of participants who complete regular screening assessments using SCREENii technology and engage with remote monitoring through the ENGAGE app, measured by frequency of use, completion rates, and sustained engagement over time.
Prevention of frailty progression and preservation of intrinsic capacity
Changes in frailty status and intrinsic capacity status across the 6 domains (mobility, cognition, mental health, hearing, vision, nutrition) following tiered screening and early intervention. Frailty status will be measured using the Fried Frailty Phenotype, reported as the proportion (%) of participants classified as frail, pre-frail, or robust. Intrinsic capacity will be evaluated using the ICOPE Step 1 screening followed by Step 2 clarification assessments for each domain: Mobility: Short Physical Performance Battery (SPPB) score (range 0-12) Cognition: Chinese Mini Mental State Examination (CMMSE) score and a single self-reported memory concern question (presence or absence) Mental health: Geriatric Depression Scale-15 (GDS-15) score Hearing: Screening audiometer results (threshold levels in decibels) Vision: Visual acuity test results using handheld Snellen chart Nutrition: Mini Nutritional Assessment Short Form (MNA-SF) score
Health-related quality of life improvement
Changes in validated quality of life measures using EuroQol 5-dimension (EQ-5D-5L) and EuroQol Visual Analogue Scale (EQ-VAS) following INFINITY-ICOPE intervention. For EQ-5D-5L, participants indicate their health by selecting one level in each of five dimensions (mobility, self-care, usual activities, pain / discomfort, anxiety / depression), producing a 5-digit code representing their health state. The EQ-VAS records self-rated health on a 0-100 scale, with endpoints labeled 'best' and 'worst' imaginable health, providing a quantitative measure of perceived health.
Healthcare service utilization
Healthcare service utilization will be assessed by the number of emergency department (ED) visits and hospitalizations occurring within the past 6 months or 1 year, depending on the timing of the study visit. The reasons for each ED visit and hospitalization will also be recorded. These measures will be compared between the intervention and control groups.
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Sengkang General Hospital
Lead sponsor
Singapore Health Services
Collaborator
Singapore General Hospital
Collaborator
Changi General Hospital
Collaborator
SingHealth Polyclinics
Collaborator
National Dental Centre, Singapore
Collaborator
Geriatric Education and Research Institute
Collaborator
National University of Singapore
Collaborator
Singapore University of Social Sciences
Collaborator
