The impact of an aging population on the Portuguese healthcare system-the primary healthcare perspective and the potential of the WHO ICOPE approach

Portugal is one of the countries where the challenges associated with an aging population are most significant. In this context, a reformulation of public health policies is required, specifically, the urgent adaptation of the Portuguese National Health Service (SNS). Founded in 1979, when Portugal had one of the youngest populations in Europe, the SNS was primarily oriented toward improving maternal-child health indicators, with primary healthcare (PHC) playing a key role. At present, the SNS needs to adapt, as some data suggest it is struggling to keep pace with the aging trend. The present SNS approach to geriatric care highlights chronic disease, multimorbidity, loss of capacity, frailty, and disability, portraying older adults as a collection of deficits requiring formal treatment. The SNS lacks professionals with solid geriatric training working in the community and forming multidisciplinary teams, with proper pathways connecting community resources to hospitals. Several studies worldwide demonstrate the adaptability, feasibility, effectiveness and scalability of the WHO ICOPE approach. However, concerns have been raised regarding its implementation, especially in low- and middle-income countries, mainly due to time constraints and lack of human and financial resources. Our research team is developing pilot fieldwork using ICOPE to better understand the capabilities of this framework. By presenting this perspective, we aim to contribute to the discussion on the potential of ICOPE within the specific Portuguese demographic context, including eventual challenges and facilitators to its adaptation in PHC, and its potential contribution to the integration of care across levels in the Portuguese setting.