{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T16:11:43Z","timestamp":1788883903442,"version":"build-2803163510"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The WHO ICOPE Step 1 tool screens decline in intrinsic capacity (IC), but its diagnostic accuracy has not been examined in Korea. This study evaluated four assessable non-sensory Step 1 domains against Korean-validated reference standards in Korean community-dwelling older adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cross-sectional study of 464 community-dwelling older adults (mean age 78.4\u202fyears; 67.9% female) from 11 community-based recruitment sites in urban and rural Jinju, South Korea. ICOPE Step 1 items were evaluated against reference standards in four assessable domains: cognition (Cognitive Impairment Screening Test [CIST], with age- and education-adjusted cutoffs), vitality (Mini-Nutritional Assessment Short-Form [MNA-SF]\u202f\u2264\u202f11), psychological well-being (Geriatric Depression Scale [GDS-15]\u202f\u2265\u202f8), and locomotion (Short Physical Performance Battery [SPPB]\u202f\u2264\u202f9). Hearing and vision were reported descriptively because objective sensory reference standards were unavailable. Sensitivity, specificity, positive and negative predictive values, area under the curve (AUC), and Cohen\u2019s kappa were calculated for each domain and for overall screening. Post-hoc analyses examined modified SPPB, BMI-augmented vitality screening, cognition calibration, adjusted urban\u2013rural differences, recruitment-source sensitivity, and prevalence-adjusted predictive values.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall, Step 1 screening across four domains showed sensitivity of 89.0%, specificity of 45.1%, and AUC of 0.671 for any IC decline. In the original SPPB-based analysis, locomotion showed the highest apparent accuracy (sensitivity 70.0%, specificity 83.6%, AUC\u202f=\u202f0.768,\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u202f=\u202f0.499), but modified SPPB analysis excluding the chair-stand component reduced AUC to 0.670, confirming incorporation bias. Psychological well-being showed AUC\u202f=\u202f0.709, whereas cognition showed limited specificity (50.2%; low-education subgroup 45.7%). Adding BMI\u202f\u2264\u202f20\u202fkg\/m\n                      <jats:sup>2<\/jats:sup>\n                      to vitality screening increased sensitivity from 59.0 to 68.2% with minimal specificity loss. Adjusted analyses showed setting-dependent detection differences, especially lower locomotion detection in urban residents.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Four assessable non-sensory ICOPE Step 1 domains showed acceptable overall case-finding sensitivity but heterogeneous domain-specific accuracy. Implementation should use education-stratified cognitive confirmation, BMI-augmented vitality screening, cautious interpretation of chair-rise locomotion results, and future objective validation of sensory domains.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1897282","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T15:40:55Z","timestamp":1785426055000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic accuracy of the WHO ICOPE step 1 screening tool in Korean community-dwelling older adults: a cross-sectional validation study"],"prefix":"10.3389","volume":"14","author":[{"given":"HeeKyung","family":"Chang","sequence":"first","affiliation":[{"name":"College of Nursing, Gyeongsang National University","place":["Jinju, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MinJi","family":"Park","sequence":"additional","affiliation":[{"name":"College of Nursing, Gyeongsang National University","place":["Jinju, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JuHee","family":"Seo","sequence":"additional","affiliation":[{"name":"College of Nursing, Gyeongsang National University","place":["Jinju, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"YoungJoo","family":"Do","sequence":"additional","affiliation":[{"name":"College of Nursing, Gyeongsang National University","place":["Jinju, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"ref1","volume-title":"Integrated Care for Older People (ICOPE): Guidance for Person-Centred Assessment and Pathways in Primary Care","year":"2019"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2145","DOI":"10.1016\/S0140-6736(15)00516-4","article-title":"The world report on ageing and health: a policy framework for healthy ageing","volume":"387","author":"Beard","year":"2016","journal-title":"Lancet"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1653","DOI":"10.1093\/gerona\/gly011","article-title":"Evidence for the domains supporting the construct of intrinsic capacity","volume":"73","author":"Cesari","year":"2018","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"ref4","volume-title":"WHO ICOPE Handbook: Guidance for Person-Centred Assessment and Pathways in Primary Care","year":"2019"},{"key":"ref5","volume-title":"Integrated Care for Older People (ICOPE): A Manual for Implementation at the District Level","year":"2024"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1186\/s12877-022-02980-1","article-title":"Intrinsic capacity of older people in the community using WHO integrated Care for Older People (ICOPE) framework: a cross-sectional study","volume":"22","author":"Leung","year":"2022","journal-title":"BMC Geriatr"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1186\/s12877-023-03799-0","article-title":"Identification of decreased intrinsic capacity: performance of diagnostic measures of the ICOPE screening tool in community dwelling older people in the VIMCI study","volume":"23","author":"Rojano","year":"2023","journal-title":"BMC Geriatr"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1186\/s12877-023-04180-x","article-title":"Diagnostic performance analysis of the integrated Care for Older People (ICOPE) screening tool for identifying decline in intrinsic capacity","volume":"23","author":"Lu","year":"2023","journal-title":"BMC Geriatr"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"2179","DOI":"10.2147\/CIA.S486663","article-title":"Sensitivity and specificity of three measures of intrinsic capacity in older people aged 80 and over in nursing homes","volume":"19","author":"Ma","year":"2024","journal-title":"Clin Interv Aging"},{"key":"ref10","volume-title":"Population Projections for Korea: 2020\u20132070","year":"2024"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e035573","DOI":"10.1136\/bmjopen-2019-035573","article-title":"Korean frailty and aging cohort study (KFACS): cohort profile","volume":"10","author":"Won","year":"2020","journal-title":"BMJ Open"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"10","DOI":"10.4235\/agmr.21.0025","article-title":"World Health Organization integrated Care for Older People (ICOPE) and the integrated Care of Older Patients with frailty in primary care (ICOOP_Frail) study in Korea","volume":"25","author":"Won","year":"2021","journal-title":"Ann Geriatr Med Res"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"100031","DOI":"10.1016\/j.jarlif.2025.100031","article-title":"Adapting WHO integrated care for older people (ICOPE) models to the Korean context: policy relevance and feasibility\u2014a Delphi survey","volume":"15","author":"Kim","year":"2025","journal-title":"J Adv Res Life"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1590\/S1980-57642009DN30200003","article-title":"The performance of the Mini-Cog in a sample of low educational level elderly","volume":"3","author":"Ribeiro Filho","year":"2009","journal-title":"Dement Neuropsychol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"590","DOI":"10.1016\/j.jamda.2020.09.044","article-title":"Differences in the association of neighborhood environment with physical frailty between urban and rural older adults: the Korean Frailty and Aging Cohort Study (KFACS)","volume":"22","author":"Seo","year":"2021","journal-title":"J Am Med Dir Assoc"},{"key":"ref16","volume-title":"CIST (Cognitive Impairment Screening Test) Manual","author":"Ko","year":"2021"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"M366","DOI":"10.1093\/gerona\/56.6.M366","article-title":"Screening for undernutrition in geriatric practice: developing the short-form Mini-nutritional assessment (MNA-SF)","volume":"56","author":"Rubenstein","year":"2001","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1080\/13607860020020618","article-title":"Cross-cultural comparability of the geriatric depression scale: comparison between older Koreans and older Americans","volume":"5","author":"Jang","year":"2001","journal-title":"Aging Ment Health"},{"key":"ref19","first-page":"48","article-title":"Validation of geriatric depression scale, Korean version (GDS) in the assessment of DSM-III-R major depression","volume":"38","author":"Cho","year":"1999","journal-title":"J Korean Neuropsychiatr Assoc"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"M85","DOI":"10.1093\/geronj\/49.2.M85","article-title":"A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission","volume":"49","author":"Guralnik","year":"1994","journal-title":"J Gerontol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1111\/j.1532-5415.1991.tb01616.x","article-title":"The timed \u2018up & go\u2019: a test of basic functional mobility for frail elderly persons","volume":"39","author":"Podsiadlo","year":"1991","journal-title":"J Am Geriatr Soc"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1074","DOI":"10.1093\/ajcn\/82.5.1074","article-title":"Appetite assessment: simple appetite questionnaire predicts weight loss in community-dwelling adults and nursing home residents","volume":"82","author":"Wilson","year":"2005","journal-title":"Am J Clin Nutr"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"808","DOI":"10.1007\/s12603-023-1985-y","article-title":"The ICOPE intrinsic capacity screening tool: measurement structure and predictive validity of dependence and hospitalization","volume":"27","author":"Rodr\u00edguez-Laso","year":"2023","journal-title":"J Nutr Health Aging"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"glae112","DOI":"10.1093\/gerona\/glae112","article-title":"Predictive capacity of the integrated Care for Older People screening tool for intrinsic capacity impairments: results from the INSPIRE-T cohort","volume":"79","author":"Giudici","year":"2024","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"159","DOI":"10.2307\/2529310","article-title":"The measurement of observer agreement for categorical data","volume":"33","author":"Landis","year":"1977","journal-title":"Biometrics"}],"updated-by":[{"DOI":"10.3389\/fpubh.2026.1970851","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000}}],"container-title":["Frontiers in Public 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