Guidance on person-centred assessment and pathways in primary care

The ICOPE guidance for person-centred assessment and pathways in primary care (ICOPE Handbook) helps community health and care workers put the recommendations outlined in the ICOPE Guidelines into practice. The Handbook assists with setting person-centred goals, screening for loss in a range of domains of intrinsic capacity and assessing health and social care needs to develop a personalised care plan. The care plan may include multiple interventions to manage declines in intrinsic capacity, provide social care and support, support self-management and support caregivers. The domains of intrinsic capacity include cognitive decline, limited mobility, malnutrition, visual impairment, hearing loss and depressive symptoms.


– Acknowledgements
– Abbreviations
1. Integrated care for older people (ICOPE)
2. Optimizing capacities and abilities: towards healthy ageing for all
3. Assessing older people’s needs and developing a personalized care plan
4. Care pathways to manage COGNITIVE DECLINE
5. Care pathways to improve MOBILITY
6. Care pathways to manage MALNUTRITION
7. Care pathways to manage VISUAL IMPAIRMENT
8. Care pathways to manage HEARING LOSS
9. Care pathways to manage DEPRESSIVE SYMPTOMS
10. Care pathways for SOCIAL CARE AND SUPPORT
11. Care pathways to SUPPORT THE CAREGIVER
12. Develop a personalized care plan
13. How health and long-term care systems can support implementation of the WHO ICOPE approach

Guidance on person-centred assessment and pathways in primary care
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