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Background The World Health Organization (WHO) has reframed health and healthcare for older people around achieving the goal of healthy ageing. The recent WHO Integrated Care for Older People (ICOPE) guidelines focus on maintaining intrinsic capacity, i.e., addressing declines in neuromusculoskeletal, vitality, sensory, cognitive, psychological, and continence domains, aiming to prevent or delay the onset of dependence. The target group with 1 or more declines in intrinsic capacity (DICs) is broad, and implementation may be challenging in less-resourced settings. We aimed to inform planning by assessing intrinsic capacity prevalence, by characterising the target group, and by validating the general approach-testing hypotheses that DIC was consistently associated with higher risks of incident dependence and death. Methods and findings We conducted population-based cohort studies (baseline, 2003-2007) in urban sites in Cuba, Dominican Republic, Puerto Rico, and Venezuela, and rural and urban sites in Peru, Mexico, India, and China. Door-knocking identified eligible participants, aged 65 years and over and normally resident in each geographically defined catchment area. Sociodemographic, behaviour and lifestyle, health, and healthcare utilisation and cost questionnaires, and physical assessments were administered to all participants, with incident dependence and mortality ascertained 3 to 5 years later (2008-2010). In 12 sites in 8 countries, 17,031 participants were surveyed at baseline. Overall mean age was 74.2 years, range of means by site 71.3-76.3 years; 62.4% were female, range 53.4%-67.3%. At baseline, only 30% retained full capacity across all domains. The proportion retaining capacity fell sharply with increasing age, and declines affecting multiple domains were more common. Poverty, morbidity (particularly dementia, depression, and stroke), and disability were concentrated among those with DIC, although only 10% were frail, and a further 9% had needs for care. Hypertension and lifestyle risk factors for chronic disease, and healthcare utilisation and costs, were more evenly distributed in the population. In total, 15,901 participants were included in the mortality cohort (2,602 deaths/53,911 person-years of follow-up), and 12,939 participants in the dependence cohort (1,896 incident cases/38,320 person-years). One or more DICs strongly and independently predicted incident dependence (pooled adjusted subhazard ratio 1.91, 95% CI 1.69-2.17) and death (pooled adjusted hazard ratio 1.66, 95% CI 1.49-1.85). Relative risks were higher for those who were frail, but were also substantially elevated for the much larger sub-groups yet to become frail. Mortality was mainly concentrated in the frail and dependent sub-groups. The main limitations were potential for DIC exposure misclassification and attrition bias. Conclusions In this study we observed a high prevalence of DICs, particularly in older age groups. Those affected had substantially increased risks of dependence and death. Most needs for care arose in those with DIC yet to become frail. Our findings provide some support for the strategy of optimising intrinsic capacity in pursuit of healthy ageing. Implementation at scale requires community-based screening and assessment, and a stepped-care intervention approach, with redefined roles for community healthcare workers and efforts to engage, train, and support them in these tasks. ICOPE might be usefully integrated into community programmes for detecting and case managing chronic diseases including hypertension and diabetes., Author(s): Martin J. Prince 1,2,*, Daisy Acosta 3, Mariella Guerra 4,5, Yueqin Huang 6, K. S. Jacob 7, Ivonne Z. Jimenez-Velazquez 8, A. T. Jotheeswaran 9, Juan J. Llibre Rodriguez [...]

Background: Cultural and religious beliefs influence perceptions about health and illness. Data, from India, on perceptions about intellectual disability are scant. This study explored people's cultural beliefs and attitudes about intellectual disability, perceived needs and burden associated with care in Vellore, south India. Method: A qualitative methodology using focus groups was employed. Eight focus groups were conducted in three settings and included the mothers of children and adolescents with intellectual disability (four groups, n = 29), community health workers (two groups, n = 17) and schoolteachers (two groups, n = 16). Results: Our results suggest that cultural and religious beliefs perpetuated negative attitudes towards disability. This meant that caregivers bore a high burden of care with little support from family or society. The study confirmed the presence of diverse, multiple and contradictory models of disability drawing from biomedical and local religious, social and cultural constructs. Conclusions: Public awareness, education and community-level interventions for reducing the misconceptions and stigma related to intellectual disability are needed in addition to culturally sensitive treatment methods to improve the attitude towards and management of intellectual disability.

Author(s): Cleusa Pinheiro Ferri 1,*, K. S. Jacob 2 The ageing of populations is the most significant social transformation of the 21st century [1] and has highlighted the importance of [...]

Background: The study aimed to evaluate the effectiveness of a social skills training program provided at the occupational therapy unit of a tertiary care center in India. Methods: The study used a pre–post interventional design where 101 consecutive patients with a diagnosis of schizophrenia or bipolar affective disorder, between 18 and 60 years, who provided written informed consent, were assessed on the Vellore Assessment of Social Performance (VASP) during the first week of attendance (baseline). Subsequently, they were enrolled in a six-session social skills group training program for two weeks. They were assessed on the VASP after one week (midterm assessment) and at the end (posttest) of the intervention. A follow-up assessment was done two weeks after cessation of the intervention. The participants were also scored on the Brief Psychiatric Rating Scale (BPRS) at four time points. Results: Repeated measures ANOVA revealed significant differences in the VASP scores between time points, that is, F (baseline, midterm) = −4.34 and P = 0.001; F (baseline, postgroup) = −6.92 and P = 0.001; and F (baseline, follow-up) = −8.71 and P = 0.001. The correlation between the BPRS and VASP scores was also significant at each time point. Conclusion: The social skills group training protocol seems to be effective and feasible for the Indian population. Since conducting multicenter clinical trials might not always be possible in resource-constrained settings, this study might be considered preliminary evidence for context-specific, peer-/family-supported social skills training. [ABSTRACT FROM AUTHOR]