Implementation of Decade of Healthy Ageing Action Plan to Screen and Prevent Decline in Intrinsic Capacity in Elders (SPICE) Through Multisectoral Collaboration in Singapore (SPICE)

This study evaluates the implementation of a structured community-based pathway to screen, risk stratify, and prevent decline in intrinsic capacity (IC) among adults aged 60 years and above in Singapore. Using the World Health Organization (WHO) Integrated Care for Older People (ICOPE) framework and digital screening tools, participants will undergo IC domain screening in community settings. Individuals identified with early decline will receive targeted multidomain interventions and/or referral to primary or specialist care as indicated. Participants will be followed longitudinally to assess feasibility, uptake, functional trajectories, and implementation outcomes.

Study Overview

• Status: Recruiting
• Conditions: Frailty; Lifestyle; Intrinsic Capacity
• Intervention / Treatment: Other: ICOPE-Based Digital Intrinsic Capacity Monitoring and Triggered Follow-up (SPICE Pathway)

Detailed Description

Population ageing is associated with progressive decline in intrinsic capacity (IC), defined by WHO as the composite of physical and mental capacities across mobility, cognition, vitality (nutrition), psychological, and sensory domains. Early detection of IC decline enables preventive, person-centred interventions to delay frailty, disability, and long-term care dependency.

The SPICE study operationalises the WHO ICOPE framework within Singapore's community ageing ecosystem through a coordinated hub-and-spoke model linking:Community screening platforms (e.g., Active Ageing Centres), Community Health Posts, Regional health system services and other social service organisations.

The pathway consists of:

Step 1: IC Screening

• Screening using WHO ICOPE Monitor tools. Step 2: In-Depth Assessment
• Participants screening positive for decline undergo structured assessment of affected domains.

Step 3: Risk Stratification & Care Planning

• Traffic-light classification (low, moderate, high risk) with personalised care plans.

Step 4: Intervention & Referral

• Multidomain community interventions (exercise, nutrition, cognitive stimulation, psychosocial engagement) or escalation to medical services when required.

Step 5: Monitoring & Follow-up

• Longitudinal follow-up with repeat IC assessments at defined intervals. The study will evaluate implementation feasibility, prevalence of IC decline, adherence to care pathways, functional outcomes, and cost-effectiveness within a real-world community system.

In addition, blood and digital biomarkers will be collected from a subgroup of study participants.

• Study Type: Observational
• Enrollment (Estimated): 2500

Contacts and Locations

• Study Contact: Name: Reshma Merchant (Associate Professor), MBChB (Edin); Phone Number: +6567724368; Email: mdcram@nus.edu.sg

Study Locations

• Singapore
  • Singapore, Singapore
    • Recruiting
    • National University Hospital
    • Contact: Sophie Swe Mar Tun; Phone Number: +6589129558; Email: mdcv613@partner.nus.edu.sg
    • Principal Investigator: Reshma Merchant, MBChB
    • Sub-Investigator: Li Feng Tan, MBBS

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

Recruitment will be conducted from Active Ageing Centre and Community Centres.

Description

Inclusion Criteria:

• pre-frail or robust older adults who can provide consent and follow instructions

Exclusion Criteria:

• frail or with terminal illness

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

Screen and Prevent Intrinsic Capacity Decline in Elders (SPICE); Community-dwelling adults robust or pre-frail aged 60 years and above who undergo WHO ICOPE-aligned digital intrinsic capacity screening, structured risk stratification, personalised multidomain community-based interventions, and longitudinal follow-up.

Other: ICOPE-Based Digital Intrinsic Capacity Monitoring and Triggered Follow-up (SPICE Pathway); Participants will undergo baseline intrinsic capacity (IC) screening using WHO ICOPE-aligned tools in community settings. Follow-up contacts/visits will occur over the study period and include: Scheduled follow-up at predefined intervals (e.g., every 3, 6-12 months) for repeat IC assessment and outcome data collection; and; Triggered (non-scheduled) follow-up that is initiated when remote/digital monitoring indicates decline in one or more IC domains, poor adherence, or when major intercurrent clinical events are reported/identified, prompting in-depth assessment, care plan adjustment, and referral to Community Health Posts, primary care, or specialist services as appropriate.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Prevalence of intrinsic capacity decline at baseline (robust / pre-frail)	Proportion of participants (restricted to robust and pre-frail at baseline) with ≥1 impaired IC domain on screening; and proportion impaired by each domain (mobility, cognition, vitality, psychological, sensory).	Baseline
Uptake of recommended actions (implementation effectiveness)	Proportion of participants who initiate at least one recommended action within a defined window after screening/plan (e.g., enrolment in a prescribed community programme, completion of recommended assessment, or attendance at a referred service).	Up to 3 months post-recommendation

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Identification of (a set of) biomarkers of aging	Both blood biomarkers and digital markers associated with various intrinsic capacity	30 months
Feasibility and reach	Proportion of individuals in each community setting complete both Step 1 and Step 2 assessment.	30 months
Change in intrinsic capacity and function over time	Change in number of impaired IC domains (0-5) from baseline to follow-up.	12 months from enrolment
Frailty progression	Proportion transitioning from robust → pre-frail/frail; pre-frail → frail	over 12 months follow up
Cost per participant screened	Programme delivery cost from the provider/programme perspective, calculated as total programme delivery cost divided by the number of participants screened; costs include personnel, training, digital platform/monitoring, screening and assessment delivery, and intervention coordination.	3 years
Number of participants with at least one unscheduled emergency department visit or hospital admission	Number and proportion of participants with at least one unscheduled emergency department visit or unplanned hospital admission during follow-up, based on participant report and/or clinical records where available.	12 months
Implementation outcomes assessed using RE-AIM framework	Reach: Proportion of eligible older adults screened, characteristics of participants. Effectiveness: Proportion of participants with identified IC impairment who receive recommended follow-up actions, including referral to community services, primary care, or multidisciplinary assessment. Adoption: Provider-reported acceptability and perceived usefulness of the screening pathway (measured using an adapted 8-item questionnaire based on the Theoretical Framework of Acceptability (TFA)). Implementation: Adherence to screening protocols among providers, completion of Step 1 and Step 2 assessments, and referral processes. Implementation strategies, barriers, and facilitators will also be documented by qualitative method. Maintenance: Continued delivery of IC screening at participating sites, and Integration of the programme into routine community health services. The 23-item Normalization Measure Development questionnaire (NoMAD) and the 12-item SCIROCCO tool will be used.	3 years

Collaborators and Investigators

• Sponsor: National University Hospital, Singapore

Publications and helpful links

Helpful Links

• Description of the WHO ICOPE Framework

Study record dates

Study Major Dates

• Study Start (Actual): April 1, 2025
• Primary Completion (Estimated): May 30, 2027
• Study Completion (Estimated): September 30, 2027

Study Registration Dates

• First Submitted: March 3, 2026
• First Submitted That Met QC Criteria: April 10, 2026
• First Posted (Actual): April 13, 2026

Study Record Updates

• Last Update Posted (Actual): April 13, 2026
• Last Update Submitted That Met QC Criteria: April 10, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: frailty; geroscience; intrinsic capacity; personalized intervention
• Additional Relevant MeSH Terms: Pathologic Processes; Pathological Conditions, Signs and Symptoms; Frailty
• Other Study ID Numbers: NICTran2023-0013 (Other Grant/Funding Number: National Medical Research Council)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: It will not be individual level data but rather a group data.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No