title: Identifying common impairments in frail and dependent older people: validation of the COPE assessment for non-specialised health workers in low resource primary health care settings.
abstract: BACKGROUND
  Frail and dependent older people in resource-poor settings are poorly served by health systems that lack outreach capacity. The COPE (Caring for Older PEople) multidimensional assessment tool is designed to help community health workers (CHWs) identify clinically significant impairments and deliver evidence-based interventions
  
  
  METHODS
  Older people (n = 150) identified by CHWs as frail or dependent, were assessed at home by the CHW using the structured COPE assessment tool, generating information on impairments in nutrition, mobility, vision, hearing, continence, cognition, mood and behaviour. The older people were reassessed by local physicians who reached a clinical judgment regarding the presence or absence of the same impairments based upon clinical examination guided by the EASY-Care assessment tool.
  
  
  RESULTS
  The COPE tool was considered easy to administer, and gave CHWs a sense of empowerment to understand and act upon the needs of older people. Agreement between COPE assessment by CHW and clinician assessors was modest (ranged from 45.8 to 91.3 %) for most impairments. However, the prevalence of impairments was generally higher according to clinicians, particularly for visual impairment (98.7 vs 45.8 %), cognitive impairment (78.4 vs. 38.2 %) and depression (82.0 vs. 59.9 %). Most cases identified by WHO-COPE were clinician confirmed (positive predictive values - 72.2 to 98.5 %), and levels of disability and needs for care among those identified by COPE were higher than those additionally identified by the clinician alone.
  
  
  CONCLUSIONS
  The COPE is a feasible tool for the identification of specific impairments in frail dependent older people in the community. Those identified are likely to be confirmed as having clinically relevant problems by clinicians working in the same service, and the COPE may be particularly effective at targeting attention upon those with the most substantial unmet needs.
authors.affiliation: Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland. amuthavallithiya@who.int.|Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland. amuthavallithiya@who.int.
authors.forename: Jotheeswaran
authors.initials: J
authors.lastname: A T
authors.affiliation: Department of Preventive and Social Medicine, Goa Medical College, Goa, India. dr_amit_dias@yahoo.com.|Sangath, Goa, India. dr_amit_dias@yahoo.com.
authors.forename: Amit
authors.initials: A
authors.lastname: Dias
authors.affiliation: Hull and East Yorkshire Hospitals NHS Trust, Hull, UK. Ian.Philp@hey.nhs.uk.
authors.forename: Ian
authors.initials: I
authors.lastname: Philp
authors.affiliation: Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland. beardj@who.int.
authors.forename: John
authors.initials: J
authors.lastname: Beard
authors.affiliation: Public Health Foundation of India, New Delhi, India. vikram.patel@lshtm.ac.uk.|Sangath, Goa, India. vikram.patel@lshtm.ac.uk.|Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK. vikram.patel@lshtm.ac.uk.
authors.forename: Vikram
authors.initials: V
authors.lastname: Patel
authors.affiliation: Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland. martin.prince@kcl.ac.uk.
authors.forename: Martin
authors.initials: M
authors.lastname: Prince
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis / Q000523:psychology; D003863:Depression / Q000175:diagnosis / Q000523:psychology; D016330:Frail Elderly / Q000523:psychology; D015577:Geriatric Assessment / Q000379:methods*; D006282:Health Personnel / Q000592:standards*; D006295:Health Resources / Q000592:standards*; D006801:Humans; D008297:Male; D009752:Nutritional Status; D011320:Primary Health Care / Q000379:methods* / Q000592:standards*