++
++
++
–Screen older adults for declines in intrinsic capacity: cognitive decline, mobility limitations, malnutrition, visual impairment, hearing loss, and depressive symptoms. (Refer to appendix “WHO ICOPE Screening Tool” in Chapter 19.)
–Further evaluate and pursue care pathways for potential limitations.
++
++
++
–Mobility:
If abnormal chair rise test (cannot rise from chair 5 times in 14 s without using arms), perform Short Physical Performance Battery.1
If SPPB score is normal or mildly limited, consider a multimodal exercise program such as Vivifrail.2
Optimize polypharmacy, osteoarthritis, osteoporosis, frailty, and pain.
–Environment: assess fall risk in physical environment, adapt home for fall prevention, consider assistive device, and identify safe space for walking.
–Nutrition: overcome barriers to good nutrition, encourage family and social dining, and arrange assistance with preparation of food.
–Vision: optimize hypertension, diabetes, and steroid use. Adapt home with lighting and contrasting colors to prevent falls and remove hazards from walking path.
–Hearing: if abnormal audiology, provide hearing age or refer to hearing specialist if severe or atypical (ear pain, drainage, dizziness, otitis media, unilateral). Provide emotional support and auditory aids for phone and doorbell.
–Depression: if depressive symptoms, offer cognitive behavioral therapy, multimodal exercise, and mindfulness practice. If significant depression, consider specialized care. Optimize polypharmacy, anemia, malnutrition, thyroid disease, and pain. Strengthen social support, minimize stressors, promote daily activities, and work against loneliness.
++
+
++
++
++
++
► USPSTF 2020, CTFPHC 2019, AAN 2021, ACR 2020
++++